A Retrospective Study of Ultrasonographic Features of Hepatic Metastases Following Adrenal Cortical Carcinoma Resection.

Background/Objectives: Liver metastasis after surgery for adrenocortical carcinoma (ACC) is a critical factor affecting patient prognosis; however, relevant ultrasound imaging features remain poorly characterized. This retrospective study aims to systematically describe the conventional ultrasound and contrast-enhanced ultrasound (CEUS) features of post-surgical hepatic metastases from ACC and to evaluate the clinical utility of ultrasonography in the diagnosis and follow-up. Methods: A total of 10 patients with post-surgical ACC liver metastases via ultrasound-guided liver biopsy between January 2000 and June 2026 at West China Hospital of Sichuan University were retrospectively enrolled. All patients underwent conventional ultrasound (B-mode and color Doppler flow imaging, CDFI) and CEUS. Given the small sample size, only descriptive statistics were performed, and all findings should be interpreted as exploratory. Results: All 10 patients were female (age range: 38-56 years), 70% had multiple lesions. On B-mode ultrasound, 80% of lesions appeared hypoechoic, 100% exhibited heterogeneous internal echotexture, 80% had irregular shapes, and 60% displayed well-defined margins. CDFI detected internal or perilesional blood flow signals in 90% of lesions, predominantly perilesional (50%). CEUS demonstrated arterial-phase hyperenhancement in all cases (50% heterogeneous hyperenhancement, 30% peripheral-dominant enhancement, and 20% ring-like nodular hyperenhancement), followed by rapid wash-out during the portal venous or delayed phases, with 100% of lesions showing hypoenhancement at 180 s. Conclusions: These exploratory findings suggest that post-surgical ACC liver metastases typically manifest on conventional ultrasound as hypoechoic, heterogeneous solid masses with variable margins and predominant perilesional blood flow. CEUS reveals a characteristic "fast-in, fast-out" malignant enhancement pattern. CEUS may serve as a useful adjunct to conventional imaging within a multimodal surveillance strategy, but larger prospective studies are needed to confirm its diagnostic value.