Published in:
01-07-2009 | Original Article—Liver, Pancreas, and Biliary Tract
Usefulness of Sonazoid contrast-enhanced ultrasonography for hepatocellular carcinoma: comparison with pathological diagnosis and superparamagnetic iron oxide magnetic resonance images
Published in: Journal of Gastroenterology | Issue 7/2009
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Objective
We investigated the usefulness of Sonazoid contrast-enhanced ultrasonography (Sonazoid-CEUS) in the diagnosis of hepatocellular carcinoma (HCC). The examination was performed by comparing the images during the Kupffer phase of Sonazoid-CEUS with superparamagnetic iron oxide magnetic resonance (SPIO-MRI).
Methods
The subjects were 48 HCC nodules which were histologically diagnosed (well-differentiated HCC, n = 13; moderately differentiated HCC, n = 30; poorly differentiated HCC, n = 5). We performed Sonazoid-CEUS and SPIO-MRI on all subjects. In the Kupffer phase of Sonazoid-CEUS, the differences in the contrast agent uptake between the tumorous and non-tumorous areas were quantified as the Kupffer phase ratio and compared. In the SPIO-MRI, it was quantified as the SPIO-intensity index. We then compared these results with the histological differentiation of HCCs.
Results
The Kupffer phase ratio decreased as the HCCs became less differentiated (P < 0.0001; Kruskal–Wallis test). The SPIO-intensity index also decreased as HCCs became less differentiated (P < 0.0001). A positive correlation was found between the Kupffer phase ratio and the SPIO-MRI index (r = 0.839). In the Kupffer phase of Sonazoid-CEUS, all of the moderately and poorly differentiated HCCs appeared hypoechoic and were detected as a perfusion defect, whereas the majority (9 of 13 cases, 69.2%) of the well-differentiated HCCs had an isoechoic pattern. The Kupffer phase images of Sonazoid-CEUS and SPIO-MRI matched perfectly (100%) in all of the moderately and poorly differentiated HCCs.
Conclusion
Sonazoid-CEUS is useful for estimating histological grading of HCCs. It is a modality that could potentially replace SPIO-MRI.