超声造影功率多普勒谐频成像在肝肿瘤诊断中的应用

目的：评价功率（俗称“能量”）多普勒超声造影检测肝肿瘤内血流信号的能力。方法：对未治疗的56例57个肝脏占位性病变进行超声造影功率多普勒谐频成像检查，其中原发性肝癌47个，胆管细胞性肝癌3个，转移性肝癌3个，肝血管瘤2个，肝局灶性结节增生2个。所有病人注射造影剂后于早期动脉相观察肿瘤内的血流灌注情况，并与动态增强CT结果比较。结果：功率多普勒谐频成像显示肝肿瘤内造影增强80．7％（46／57）、负性增强19．3％（11／57）。与动态增强CT相比，功率多普勒谐频成像显示肿瘤内血流信号的敏感性、特异性和准确性分别为83．6％、100％和84．2％。肿瘤的深度是影响谐频成像结果的重要因素。结论：对一定深度范围内的肝肿瘤，功率多普勒谐频成 像可以敏感而准确地显示不同肝肿瘤的血流灌注情况，估计肿瘤血供特点，有助于肝肿瘤的诊断和鉴别诊断。     

超声造影反向脉冲谐频成像技术诊断原发性肝癌

目的：分析原发性肝癌在反向脉冲谐频成像超声造影时的表现。方法：使用反向脉冲谐频成像技术和微泡型超声造影剂，对52例58个原发性肝癌结节进行超声造影检查，分析肝癌内血流信号的增强表现。结果：反向脉冲谐频成像的连续成像可实时动态地显示肝癌内增生扭曲的肿瘤血管，间歇成像可显示肝癌的血流灌注情况。谐频成像超声造影显示大部分的肝癌结节为富血供肿瘤,未显示肿瘤内血流信号的肝癌为少血供型肿瘤。谐频成像声像图无明显的运动伪差，成像质量高。结论：反向脉冲谐频成像造影可清晰地显示肝癌内的血流信号，其提供的肿瘤血管影像和血流灌注信息，可为肝癌的诊断提供血流动力学方面的依据。     

肝占位性病变的超声造影双向脉冲谐频成像表现

目的：探讨不同的肝占位性病变在超声造影编码双向脉冲谐频成像时的表现特征。方法：对未治疗的73例患者肝细胞性肝癌,胆管细胞性肝癌,转移性肝肿瘤、肝血管瘤和肝局灶性结节增生）共80个肝占位性病变进行超声造影下的编码双向脉冲谐频成像检查,并于造影后比较肿瘤内与肝实质的血流信号强度。结果：原发性肝癌中93．1％（54／58）在超声造影谐频成像的连续成像上表现为造影增强,并可动态显示内部增生扭曲的肿瘤血管：77．6％（45／58）在间歇成像上呈现造影增强,显示肿瘤的灌注血流。胆管细胞性肝癌中100％（3／3）在连续成像上呈现造影增强,显示的肿瘤血管较粗大;间歇成像则显示66．7％）2／3）造影增强。转移性肝肿瘤表现为肿瘤周边部信号增绐,肝血管瘤在间歇成像上显示肿瘤内的发布不均匀,呈现“棉絮”证。肝局灶性结节增生则可显示其中央动脉及放谢状分支供血的特征性表现。结论：超声造影编码双向脉冲谐频成像可敏感地显示肝占位性病变内的血流信号,不同的占位性病变呈现不同的造影增强表现,有助于肝占位性病变的诊断的鉴别诊断。     

肝肿瘤实时灰阶谐波超声造影与彩色多普勒超声造影比较研究

目的比较实时灰阶谐波超声造影与彩色多普勒超声造影在评价肝肿瘤血供情况中的价值.方法对32例患者进行彩色多普勒超声造影和实时灰阶谐波超声造影,其中恶性肿瘤19例(原发性肝癌17例,转移性肝癌2例),肝血管瘤5例,局灶结节性增生5例,肝硬化结节1例,局灶性脂肪分布不均2例.比较两种方法反映肝肿瘤血供情况的能力,与病理及动态增强CT对照.结果彩色多普勒超声造影和实时灰阶谐波超声造影对血流的显示率分别为90.7%(29/32),100%(32/32),两种方法在判断肿瘤有无血供方面无明显差异.两种方法均可观察肿瘤增强的时相变化,实时灰阶谐波超声造影对肝实质内微血管血供的显示优于彩色多普勒成像,可判断肿瘤的坏死情况.结论实时灰阶谐波超声造影可有效的显示肿瘤内的血供,并可动态观察肿瘤的血流灌注情况,其效果明显优于彩色多普勒超声造影.     

超声观察应用肝动脉栓塞合并微波热凝固方法治疗肝癌疗效的评价

目的：应用能量多普勒超声评价肝动脉栓塞化疗合并超声引导下微波热凝固治疗肝癌的疗效。方法：35例共56个结节经组织学诊断证实的肝癌患，首先采用肝动脉栓化疗，术后1－2天内进行超声引导下微波微凝固治疗。结果：56个结节能量多普勒超声检查治疗前结节内有血流信号50个，治疗后血流信号消失41个，占82％，采色多普勒超声检查治疗前结节内有血流信号45个，治疗后血流信号消失39个，86．7％，结论：能量多普勒超声优于彩色多普勒超声，是评价肝癌介入治疗的有效方法。     

编码谐波造影在小肝癌瘤内血流检测中的应用

目的：探讨编码谐波声学造影在检出小肝癌内血流信号中的应用价值。方法：对106个最大直径不超过3cm的肝癌结节行编码谐波声学造影检查，造影剂为levovist，分别在早期动脉相和门脉相评价肝癌瘤内的血流信号，所得结果与三相动态CT，数字减影血管造影和MRI对比。结果：106个肝癌结节中98个可在早期动态相和／或门脉相检出瘤内血流信号，以三相动态CT结果为金标准，其检出的敏感性，特异性和准确性分别为95．1％，100％和95．3％。其对瘤内血流的检出率（92．5％）与三相动态CT（97．2％，P＝0．14）和数字减影血管造影（88．9％，P＝0．53）相比无显著性差异，而较MRI的检出率（69．4％）高（P＝0．001）。结论：编码谐波声学造影能有效地检出小肝癌内的血流信号，并为早期诊断小肝癌提供重要信息。     

能量谐波成像声学造影在肝动脉栓塞治疗肝癌中的应用

目的 探讨能量谐波成像声学造影在肝动脉栓塞治疗中的效应价值。方法 对１４例肝癌患者肝动脉塞化疗前后行能量多普勒超声和能量谐波成像声学造影检查,声学造影剂为Ｌｅｖｏｖｉｓｔ。结果 栓塞前,能量多普勒超声检查３例病灶内未见血流信号,能量谱波成旬声学造影检查１４例病灶内均检出搏动血流信号;栓塞后,能量多普勒超声检查９例病灶内未见血流信号,能量谐波成像声学造影检查１１例病灶内检出血流信号。血流信号增强强度     

能量多普勒及造影增强超声观察微波凝固治疗兔VX2肝癌疗效的初步研究

目的　应用能量多普勒及超声造影在微波凝固治疗兔VX2 肝癌后进行疗效评价。方法　建立 10个VX2 肝癌模型 ,开腹对VX2 肿瘤行微波辐射 (波长 9mm)治疗 ,每次 60W× 12 0s。微波治疗前后均行二维、能量多普勒及超声造影 (Levovist ,3 0 0mg/ml,0 .3ml/kg)观察 ,取肿瘤标本行病理检查。结果微波治疗即刻二维超声示沿微波天线呈强回声窄带样改变 ,周围呈较宽而均匀的低回声 ,肿瘤边缘变得不清晰。微波治疗后能量多普勒检查 4只VX2 肿瘤结节见血流增强信号 ,而超声造影示 10只VX2 肿瘤结节均可见血流增强信号 ,病理证实为不完全坏死。结论　超声造影能更灵敏地评价微波凝固治疗VX2 肿瘤的疗效 ,残存瘤组织表现为肿瘤内持续造影增强。     

肝肿瘤实时灰阶谐波超声造影与动态增强螺旋CT对照研究

目的 探讨实时灰阶谐波超声造影和动态增强螺旋CT对肝局灶性病变的诊断价值.方法 选择肝局灶性病变患者49例,共54个病灶.其中包括原发性肝癌29个,转移性肝癌4个,肝血管瘤11个,肝局灶性结节增生7个,肝硬化结节1个,肝脂肪浸润不均2个.分别进行实时灰阶谐波超声造影和动态增强螺旋CT检查,比较肝肿瘤在两种成像方法中的表现.结果 两种成像方法显示的肝肿瘤在不同时相的表现及在动脉相的增强类型相一致.超声造影鉴别诊断肝良恶性病变的敏感性、特异性和准确性分别为 90.9%（30/33）、90.5%（19/21）和 90.7%（49/54）;动态增强螺旋CT鉴别诊断肝良恶性病变的敏感性、特异性、准确性分别为 90.9%（30/33）、95.2%（20/21）和 92.6%（50/54）,二者鉴别肝局灶性病变良恶性的能力差异无显著性意义.结论 实时灰阶谐波超声造影和动态增强螺旋CT均能反映肝病变的血流动力学特性,均有助于肝肿瘤的鉴别诊断.     

肝癌的彩色多普勒及三维血流能量成像与肝动脉血管造影对比研究

目的：探讨彩色多普勒及三维血流能量成像在肝癌中应用。方法： 用能量多普勒超声检查６５例肝癌,有４０例同时观察三维血流能量图, ２２例进行选择性肝动脉血管造影。结果： 彩色多普勒能量图使肝癌肿瘤血流显示明显高于彩色多普勒血流图。三维血流能量图可获较完整肝癌肿瘤血流立体血管网图像,且与选择性肝动脉血管造影的血管分布特征相似。结论：彩色多普勒及三维血流成像能直观较完整地表现肝癌肿瘤血流分布状态,灵敏度高,重复性好。值得临床推广应用。     

Diagnosis of advanced hepatocellular carcinoma using contrast-enhanced harmonic gray-scale imaging with enhancement agents (Levovist): Correlation with helical CT and US angiography

We compared contrast-enhanced harmonic gray-scale imaging with helical CT and US angiography to evaluate vascularity in advanced hepatocellular carcinoma (HCC). Contrast-enhanced harmonic gray-scale imaging using Levovist (Nihon Schering, Tanabe) as the contrast agent and enhanced helical CT were performed on 38 patients with 45 lesions (29 men and 9 women aged 41 to 83 years; mean age, 66 years; mean maximum tumor diameter, 30.5±23.0 mm), and angiography was performed to evaluate 37 lesions from 32 of these 38 patients (24 men and 8 women, aged 41 to 79 years; mean age, 65 years; mean maximum tumor diameter, 27.9±17.9 mm). Contrast-enhanced harmonic gray-scale imaging showed hypervascular enhancement in 41 of the 45 lesions; the other 4 lesions were not visualized as hypervascular because 3 of the them could not be detected with non-enhanced US and the remaining lesion was situated deep in the liver and more than 11 cm from the surface of the body. Helical CT showed areas of high attenuation in 40 of the 45 lesions, leaving the other 5 lesions equivocal, while US angiography achieved positive enhancement in 36 of 37 lesions. Intratumoral vessels were visualized with contrast-enhanced harmonic gray-scale imaging in 25 of the 45 lesions; however; intratumoral vessels were seen in only 4 of the 45 lesions examined with helical CT. In evaluating vascularity in advanced HCC, contrast-enhanced harmonic gray-scale imaging with Levovist was as effective as US angiography and more effective than helical CT. Motion artifacts produced by the heart make it difficult to evaluate vascularity in advanced HCC located in the left lobe of the liver with Doppler sonography. Contrast-enhanced harmonic gray-scale imaging can show intratumoral vessels and hypervascular enhancement of the tumor without motion artifacts, however, even when the tumor is located near the heart or large vessels. Contrast-enhanced harmonic gray-scale imaging is useful for evaluating vascularity in advanced HCC when the tumor can be visualized with non-enhanced US.     

Detection of tumor vascularity in hepatocellular carcinoma with contrast-enhanced Dynamic Flow imaging: Comparison with contrast-enhanced power Doppler imaging

Objective: To compare the effectiveness of contrast-enhanced Dynamic Flow imaging and contrast-enhanced power Doppler imaging using Levovist^? as a microbubble contrast agent in evaluating intratumoral vascularity in hepatocellular carcinoma (HCC).Materials and Methods: Twenty-nine patients with 54 hepatocellular carcinoma nodules (before treatment, 31; after treatment, 23) were studied with both Dynamic Flow and power Doppler imaging with intravenous injection of Levovist^?. Tumor vascularity was categorized as 0, no blood flow signals within the tumor; 1, dotlike blood flow signals within the tumor; 2, moderate blood flow signals within the tumor; and 3, abundant blood flow signals within the tumor. Detectability of intratumoral vascularity of hepatocellular carcinoma in three groups based on tumor depth, blooming and noise artifacts on contrast-enhanced Dynamic Flow and contrast-enhanced power Doppler imaging were also compared with results obtained using dynamic CT as a the gold standard. The effectiveness of contrast-enhanced Dynamic Flow and contrast-enhanced power Doppler imaging in assessing therapeutic effect were compared at the same time.Results: The ability of contrast-enhanced Dynamic Flow Doppler imaging to detect tumor vascularity in the superficial and intermediate hepatocellular carcinoma groups was close to that of contrast-enhanced power Doppler imaging (p>0.05). However, contrast-enhanced Dynamic Flow imaging demonstrated tumor parenchymal stain in 28 hepatocellular carcinoma nodules (61%), which was not detected by contrast-enhanced power Doppler imaging. Further, significantly fewer artifacts appeared in contrast-enhanced Dynamic Flow imaging than in contrast-enhanced power Doppler imaging (p<0.001). In assessing therapeutic response, the sensitivity of contrast-enhanced Dynamic Flow imaging was similar to that of dynamic CT. In deep areas, however, those more than 6 cm below the surface of the body, contrast-enhanced Dynamic Flow imaging was less sensitivity than contrast-enhanced power Doppler imaging (p=0.005).Conclusion: Contrast-enhanced Dynamic Flow imaging provides an effective approach to assessing intratumoral vascularity and therapeutic response in HCC lesions situated less than 6 cm from the surface of the body. It is superior to contrast-enhanced power Doppler imaging in its ability to detect tumor parenchymal stain and production of fewer artifacts.     

Detection of intratumoral vascularity in small hepatocellular carcinoma by coded phase inversion harmonics

OBJECTIVE: To investigate the value of contrast-enhanced coded phase inversion harmonic imaging (PIHI) in the depiction of intratumoral vascularity in small hepatocellular carcinoma (HCC). METHODS: Eighty-five patients with 106 HCCs < or =3 cm in diameter were evaluated with coded harmonic angio (CHA), a coded PIHI, with use of an intravenous contrast medium, Levovist. Intratumoral vessels were detected in the early arterial phase, and tumor parenchymal stain was demonstrated in the late vascular phase. The detectability of intratumoral vascularity on contrast-enhanced CHA was compared with that on dynamic computed tomography (CT) and digital subtraction angiography (DSA). RESULTS: With a combination of both vessel images and parenchymal flow images demonstrated by contrast-enhanced CHA, 98 of 106 small HCCs were evaluated as being hypervascular or isovascular. Using the results on dynamic CT as a gold standard, the sensitivity, specificity and accuracy were 95.1, 100 and 95.3%, respectively. The detection rate of intratumoral vascularity by contrast-enhanced CHA was 92.5% (98/ 106), compared with 97.2% (103/106) on dynamic CT (p = 0.14) and 88.9% (40/45) on DSA (p = 0.53). CONCLUSIONS: Contrast-enhanced coded PIHI is a sensitive tool for depicting intratumoral vascularity of small HCC.     

Evaluation of transcatheter arterial embolization therapy on hepatocellular carcinomas using contrast-enhanced harmonic power Doppler sonography: comparison with CT,power Doppler sonography,and dynamic MRI

Purpose The aim of this study was to assess and compare the sensitivity of power Doppler sonography, contrast-enhanced sonography, plain computed tomography (CT), and dynamic magnetic resonance imaging (MRI) for detecting hepatocellular carcinoma (HCC) nodules incompletely treated with transcatheter arterial embolization (TAE). Methods A total of 63 unresectable HCC nodules were examined in this study. The HCCs were treated with TAE. All patients underwent plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI 1 week after TAE. The sensitivity of each modality to incompletely treated HCC nodules was compared. Detection of the residual viable HCC on angiography or tumor biopsy was regarded as the gold standard for the diagnosis of incomplete treatment. Results Twenty-four nodules (38%) were diagnosed as incompletely treated. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these incompletely treated nodules were 42% (10/24), 46% (11/24), 88% (21/24), and 79% (19/24), respectively. Eighty percent (19 nodules) of the 24 incompletely treated nodules were located within a depth of less than 8 cm. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these superficial incompletely treated nodules were 37% (7/19), 53% (10/19), 100% (19/19), and 74% (14/19), respectively. In contrast, the sensitivities of each modality to deeply located nodules were 60% (3/5), 20% (1/5), 40% (2/5), and 100% (5/5), respectively. Conclusion Plain CT and power Doppler sonography had a low sensitivity to HCC nodules incompletely treated with TAE. Except for those that were deeply located, contrast-enhanced harmonic sonography showed the highest sensitivity in detecting incompletely treated HCC nodules.     

肝细胞癌的灰阶超声、彩色多普勒超声和超声造影的对比研究

目的通过肝细胞癌(HCC)的灰阶超声、彩色多普勒超声(CDFI)和超声造影(CEUS)诊断的对比研究,探讨超声造影在肝细胞癌诊断中的优势。方法肝细胞癌患者20例,共26个病灶,均经手术或穿刺活检病理证实为肝细胞癌;分别用灰阶超声、彩色多普勒超声和超声造影检查,观察肿瘤的大小、回声强度、肿瘤内的血管和肿瘤实质的血流灌注。结果在肿瘤结节的形态上,超声造影与灰阶超声基本相似,但在肿瘤直径和面积的测值上,超声造影大于灰阶超声,存在显著差异(P<0.01),而且可以发现灰阶超声所不能显现的病灶。超声造影与彩色多普勒均显示肿瘤的血管和血供,但在显示肿瘤的微血管和血流灌注时,超声造影明显优于彩色多普勒(P<0.01)。肝细胞癌超声造影血管相的增强方式与细胞分化程度有一定的相关性。结论超声造影是实时、有效显示肝细胞癌肿瘤血管和血流灌注的方法。在HCC探测和定性方面明显优于灰阶超声和彩色多普勒超声,而且对肝细胞癌的恶性程度可做出一定的判断。     

Assessment of image quality of contrast-enhanced power doppler imaging in hepatocellular carcinoma with the personal ultrasound imager: Comparison with the conventional machine

Objective To evaluate the usefulness of contrast-enhanced power Doppler imaging with the personal ultrasound imager in depicting intratumoral vascularity in hepatocellular carcinoma. Materials and Methods Contrast-enhanced power Doppler imaging was used to examine 52 hepatocellular carcinoma nodules in 29 patients, using both the personal ultrasound imager and the conventional ultrasound machine in combination with intravenous injection of Levovist^?. Results obtained using dynamic CT were used as the gold standard. The ability of the personal ultrasound imager to detect intratumoral vascularity was compared with that of the conventional ultrasound machine, and the usefulness of the personal ultrasound imager in assessing therapeutic effect after nonsurgical treatment was compared with that of dynamic CT at the same time. Results The personal ultrasound imager and the conventional ultrasound machine, using the fundamental power Doppler imaging mode (p=0.13) and contrast-enhanced power Doppler imaging mode (p=0.41), did not differ significantly in depicting the vascularity of the 52 hepatocellular carcinomas. The sensitivity, specificity, and accuracy of contrast-enhanced power Doppler imaging on the personal ultrasound imager were 95.5%, 87.5%, and 94.2%, respectively, in close agreement with results obtained using dynamic CT. After the 22 hepatocellular carcinomas were treated, the personal ultrasound imager provided diagnostic accuracy of 90.9% on residual tumors when compared with results obtained by dynamic CT, and results obtained using the conventional ultrasound machine were similar. Conclusion The highly portable personal ultrasound imager using Levovist^?-enhanced power Doppler imaging can clearly depict the intratumoral vascularity of hepatocellular carcinoma nodules before and after treatment, achieving results very close to those obtained using the conventional diagnostic ultrasound machine. The personal ultrasound imager is an alternative to the conventional ultrasound machine for depicting tumor vascularity.     

低机械指数谐波超声造影评估肝细胞癌介入治疗效果

目的 探讨低机械指数谐波超声造影在肝细胞癌(HCC)介入治疗中对疗效的评估价值.方法 对82例介入治疗的HCC患者分别于治疗前后进行低机械指数超声谐波造影、常规二维灰阶超声、彩色多普勒血流成像(CDFI)和增强CT和(或)MRI检查,记录病灶数目、大小,观察病灶内血供.结果 82例患者介入治疗前二维超声及CDFI共检出病灶119个,超声造影共检出病灶142个;治疗前后超声造影显示病灶范围均较二维超声所示增大;病灶内血流信号检测以超声造影最准确.结论 超声造影能较好地评估HCC介入治疗的疗效.     

Contrast-enhanced power Doppler sonography and helical computed tomography for assessment of vascularity of small hepatocellular carcinomas before and after percutaneous ablation

PURPOSE: We compared the usefulness of Levovist-enhanced power Doppler imaging (PDI) and helical CT in the depiction of tumor vascularity before and after percutaneous ablation of small hepatocellular carcinomas (HCCs). METHODS: Thirty-one cirrhotic patients with solitary unresectable HCCs smaller than 5 cm (mean size, 2.7 +/- 0.8 cm; range, 1.5-5.0 cm) recruited over a 15-month period were treated with percutaneous ethanol injection (n = 9) or radiofrequency ablation (n = 22). PDI, contrast-enhanced PDI (using Levovist), and multiphase contrast-enhanced helical CT were performed before and after percutaneous ablation, and vascularity findings were compared. RESULTS: Levovist significantly increased baseline intratumoral Doppler signals on PDI compared to non-contrast PDI. The most frequent tumor vascularity pattern was heterogeneous (45%). Vascularity was identified in all tumors by both contrast-enhanced PDI and helical CT before ablation. After percutaneous ablation, intratumoral vascularity was detected in 11 tumors by contrast-enhanced PDI and in 15 tumors by CT. The sensitivity, specificity, and diagnostic accuracy of contrast-enhanced PDI in demonstrating intratumoral vascularity, with CT being the gold standard, were 66%, 93%, and 81%, respectively. There was significant agreement between the 2 modalities in the depiction of tumor vascularity after ablation (kappa = 0.6, p = 0.001). However, there were 5 false negatives and 1 false positive with contrast-enhanced PDI. Complete tumor necrosis was achieved in 21 patients (68%). CONCLUSIONS: There was a good concordance between contrast-enhanced PDI and helical CT in the depiction of HCC vascularity before and after percutaneous ablation. However, although contrast-enhanced PDI may be useful for real-time guidance of treatment, its low sensitivity makes it inadequate to accurately assess the completeness of ablation.     

Contrast advanced dynamic flow imaging and contrast pulse subtraction imaging: Preliminary results in hepatic tumors

Purpose

To investigate the usefulness of contrast advanced dynamic flow imaging and contrast pulse subtraction imaging in the intranodular hemodynamics of hepatic tumors.

Materials and Methods

Ten patients underwent contrast advanced dynamic flow imaging and contrast pulse subtraction imaging using Levovist^®, a microbubble contrast agent. Fourteen hepatic tumor nodules were studied: 9 were hepatocellular carcinoma, 1 metastasis, 1 hemangioma, 1 adenomatous hyperplasia, and 2 metastatic lymph nodes of hepatocellular carcinoma. Real-time scanning of contrast advanced dynamic flow imaging and intermittent interval-delay scanning of contrast pulse subtraction imaging were carried out in the early arterial phase, the late vascular phase, and the postvascular phase. The results obtained from contrast advanced dynamic flow imaging and contrast pulse subtraction imaging were compared with those obtained by precontrast power Doppler imaging and three-phase dynamic CT, respectively.

Results

The rate of detection of intranodular vascularity by contrast advanced dynamic flow imaging (93%) or contrast pulse subtraction imaging (93%) was significantly higher than that of precontrast power Doppler imaging (29%) and was as high as that of dynamic CT. Characteristic intranodular hemodynamics were detected in hepatocellular carcinoma, metastasis, hemangioma, and adenomatous hyperplasia with typical appearance of an intranodular blood vessel image in the early arterial phase, a parenchymal stain image in the late vascular phase, and a perfusion defect image in the post-vascular phase.

Conclusion

Contrast advanced dynamic flow imaging and contrast pulse subtraction imaging clearly show the intranodular hemodynamics in hepatic tumors.