Early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma: utility of gray scale harmonic ultrasonography with a microbubble contrast agent.

OBJECTIVE: To evaluate the utility of gray scale harmonic ultrasonography with a microbubble contrast agent in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma. METHODS: Seventy-five patients with 81 nodular hepatocellular carcinomas (1.3-4.8 cm) treated with percutaneous radio frequency ablation were evaluated with contrast-enhanced gray scale harmonic ultrasonography after intravenous bolus injection of a galactose-based microbubble contrast agent. The vascularity within the ablation zones was evaluated with a continuous scan for 3 to 5 seconds between 15 and 30 seconds after initiation of contrast agent injection. To evaluate the perfusion of the ablation zones, intermittent stimulated acoustic emission imaging was performed with a rapid sweeping technique from the end of the continuous scan. All patients underwent follow-up 3-phase helical computed tomography at 1 month after radio frequency ablation and were followed for at least 1 year. The results of contrast-enhanced ultrasonography were compared with those of follow-up computed tomography in terms of the presence or absence of residual unablated tumors. RESULTS: In 10 (12%) of the 81 treated hepatocellular carcinomas, contrast-enhanced ultrasonography showed either nodular or crescentic enhancing foci at the margins of ablation zones, suggesting residual unablated tumors. Contrast-enhanced computed tomography obtained 1 month after radio frequency ablation confirmed the residual unablated tumors in the same 10 lesions. Diagnostic agreement between 1-month follow-up computed tomography and contrast-enhanced ultrasonography was achieved in all 81 cases (100%). CONCLUSIONS: Contrast-enhanced gray scale harmonic ultrasonography can be a reliable alternative to contrast-enhanced computed tomography in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.     

Therapeutic response evaluation of malignant hepatic masses treated by interventional procedures with contrast-enhanced agent detection imaging.

OBJECTIVE: To assess the usefulness of microbubble contrast-enhanced agent detection imaging in evaluating the therapeutic response of malignant hepatic masses to treatment with interventional procedures. METHODS: Fifty-eight patients with 68 hepatocellular carcinomas and 6 metastases who were treated with interventional procedures were evaluated with SH U 508A-enhanced agent detection imaging and helical computed tomography. Helical computed tomography was also performed to help establish the outcome of therapy with unenhanced computed tomography 2 weeks after transcatheter arterial chemoembolization and with dynamic contrast-enhanced computed tomography 1 day after radio frequency ablation or percutaneous ethanol injection. The studies were reviewed separately and randomly, and the sensitivity and specificity of agent detection imaging for detection of viable tumor residue were determined by follow-up imaging performed at least 3 months later. RESULTS: Follow-up computed tomography or magnetic resonance imaging revealed complete tumor responses in 44 (59.5%) of 74 cases after the therapeutic procedures. The sensitivity of agent detection imaging was 94.7% after transcatheter arterial chemoembolization and 72.7% after radio frequency ablation and percutaneous ethanol injection. The specificity of agent detection imaging for the detection of residual tumors was 80% after transcatheter arterial chemoembolization and 79.2% after radio frequency ablation and percutaneous ethanol injection. The false-positive rate for agent detection imaging in cases of radio frequency ablation or percutaneous ethanol injection was 20.8% (5 of 24), resulting from reactive hyperemia or vascularity within the safety margin. In the assessment of the therapeutic effects, the concordance of contrast-enhanced agent detection imaging with helical computed tomography was statistically significant after transcatheter arterial chemoembolization (P < .00001) and radio frequency ablation or percutaneous ethanol injection (P < .02). CONCLUSIONS: Contrast-enhanced agent detection imaging proved useful and as effective as helical computed tomography for evaluating the therapeutic effects of interventional therapeutic procedures for malignant hepatic masses.     

Small hepatocellular carcinoma: therapeutic effectiveness of percutaneous radio frequency ablation therapy with a LeVeen needle electrode.

OBJECTIVE: To evaluate the therapeutic effectiveness of percutaneous radio frequency ablation of small (< or =3-cm) hepatocellular carcinoma with a LeVeen needle electrode. METHODS: Thirty patients (mean age, 65.7 years) with 32 hepatocellular carcinomas (range, 1.2-3.0 cm; mean, 2.3+/-0.5 cm) underwent percutaneous radio frequency ablation to the center of the hepatocellular carcinoma after expansion of the inner needles. The manufacturer's recommended radio frequency ablation protocol was used. Posttreatment contrast-enhanced color Doppler sonography, contrast-enhanced computed tomography, and fine-needle biopsy were performed to assess the radio frequency ablation-induced coagulated necrosis. RESULTS: Severe intratreatment pain made us abort radio frequency ablation in 2 patients. Complete tumor necrosis was achieved in 1 treatment session with 1 needle electrode insertion in 28 (93.4%) of 30 nodules (28 patients). We found no residual focus on both color Doppler sonography and computed tomography after any of the sessions. In follow-ups ranging from 3 to 15 months (mean, 8.4 months), no local recurrence was found in cases with complete tumor ablation. CONCLUSIONS: Radio frequency ablation with the LeVeen needle electrode was effective, obtaining complete coagulated necrosis with a safety margin when used for the treatment of small hepatocellular carcinomas.     

超声引导下射频消融治疗肝癌的临床价值

目的探讨超声引导下射频消融(RFA)治疗肝癌的疗效。方法35例肝癌49个病灶行超声引导下RFA治疗,对治疗前后病灶的超声影像、超声造影、螺旋CT检查、肝功能、AFP变化以及机体免疫功能的影响等进行综合研究以评价疗效。结果RFA后5min,超声造影,肿块中83.7%(41/49)各个时相无增强,即回声缺失;1周后彩超示肿块中87.8%(43/49)血流信号明显减少或消失;1个月后螺旋CT扫描肿块中81.6%(40/49)大小无明显变化,但肿块内无强化。肝功能有不同程度改善,甲胎蛋白下降,CD4 、CD4 /CD8 明显升高,sIL-2R明显降低。结论超声引导下射频消融治疗肝癌是有效的微创治疗手段,其为操作简便、损伤小、安全性高的有效方法。     

Evaluation using contrast-enhanced harmonic gray scale sonography after radio frequency ablation of small hepatocellular carcinoma: sonographic-histopathologic correlation.

OBJECTIVE: To evaluate the usefulness of contrast-enhanced harmonic wideband gray scale sonographic images obtained after radio frequency-induced coagulation necrosis, we compared the morphologic and histopathologic characteristics of the ablated tumors with sonographic images of the tumors. METHODS: Forty-eight patients with 72 hepatocellular carcinomas with a maximal diameter of 3 cm or less were treated percutaneously using radio frequency ablation. Six treated tumors in 4 patients were resected 1 month after ablation; the remaining 66 treated tumors were evaluated by a biopsy procedure performed with an 18-gauge fine needle 1 month after ablation. The excised tumors and biopsy specimens were then examined by histopathologic methods, and the findings were compared with those obtained on contrast-enhanced harmonic wideband gray scale sonography. Hematoxylin-eosin-stained specimens were inconclusive as to whether cellular viability remained; therefore, cell viability was determined by a positive result after histochemical (lactate dehydrogenase and nicotinamide adenine dinucleotide phosphate-diaphorase) staining. RESULTS: Contrast-enhanced harmonic wideband gray scale sonography after radio frequency ablation showed residual tumor enhancement in 5 (6.9%) of the 72 tumors; the histopathologic results for these 5 tumors were also positive for tumor residue. The remaining 67 tumors (93.1%) did not show any residual tumor enhancement when examined by sonography; however, only 66 tumors did not reveal tumor residue when examined histopathologically. Contrast-enhanced harmonic wideband sonographic imaging provided results that were comparable with histopathologic findings, the criterion standard for diagnosis; the sensitivity and specificity of the sonographic images for the detection of residual tumor tissue in ablated tumors were 83.3% (5 of 6) and 100% (66 of 66), respectively. CONCLUSIONS: Contrast-enhanced harmonic wideband gray scale sonography is a potentially useful technique for evaluating the therapeutic effects of radio frequency ablation on hepatocellular carcinoma.     

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.     

Flash echo gray scale imaging with subtraction in assessment of small hepatocellular carcinoma treated with percutaneous ethanol injection: preliminary report.

OBJECTIVE: To assess the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma by using a flash echo imaging system, a newly developed technique for detecting echoes from microbubble contrast agents more efficiently. METHODS: Six patients with 7 small nodular hepatocellular carcinomas, proved by fine-needle aspiration cytologic or pathologic examination, were included. Percutaneous ethanol injection was performed until there was no intratumoral color signal on conventional color and power Doppler ultrasonography. A bubble contrast agent was then injected, and flash echo imaging in the subtraction mode was performed for assessment of the therapeutic effect. Dynamic computed tomography, magnetic resonance imaging, and hepatic angiography were also used for evaluation of the therapeutic effect. RESULTS: Five tumors had perfusion defects that were equal in size to or larger than the tumors. No tumor stain was shown on hepatic angiography. Two tumors had partial perfusion defects. Viable tumors were confirmed by tumor resection in 1 case and cytologic examination in the other. CONCLUSIONS: Our preliminary results show that flash echo imaging with subtraction has potential value in evaluation of the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma.     

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

OBJECTIVE: To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. METHODS: Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. RESULTS: After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. CONCLUSIONS: Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.     

脉冲反向谐波实时超声造影与增强螺旋CT诊断肝占位病变的比较研究

目的 比较实时超声造影与增强螺旋CT显示肝占位病变血流灌注特点的能力，探讨超声造影在肝肿瘤鉴别诊断中的应用价值。方法 对109例经手术或超声引导穿刺活检病理确诊的肝占位（原发性肝癌61例，转移性肝癌15例，肝内胆管细胞癌5例，血管瘤12例，肝硬化增生结节5例，肝细胞腺瘤2例，胆管细胞腺瘤1例，局灶性结节增生3例，局灶性坏死4例，血管平滑肌脂肪瘤1例）术前分别进行实时超声造影和造影剂增强16层螺旋CT检查，将两种检查的术前诊断与术后病理结果进行比较分析。结果 超声造影漏诊原发性肝癌2例、转移性肝癌1例，误诊原发性肝癌5例、胆管癌1例、胆管腺瘤1例、肝硬化结节1例、血管瘤1例、局灶性结节增生1例。增强CT漏诊原发性肝癌3例、转移性肝癌2例、血管瘤1例、肝硬化增生结节1例，误诊原发性肝癌7例、胆管癌2例、胆管腺瘤1例、血管瘤3例、肝硬化结节2例、局灶性结节增生2例、局灶性坏死2例。超声造影诊断肝占位病变的检出率为97．25％，增强CT的检出率为93．58％；超声造影诊断肝肿瘤的准确性为90．83％，增强CT的准确性为82．57％。结论 实时超声造影对肝占位病变的诊断能力与增强螺旋CT相近，实时超声造影具有独立诊断价值，对于增强CT扫描阴性或未显示病灶血流灌注特点的病例，超声造影具有更重要的临床意义。     

Ablation therapy guided by contrast-enhanced sonography with Sonazoid for hepatocellular carcinoma lesions not detected by conventional sonography.

OBJECTIVE: We evaluated the usefulness of contrast-enhanced harmonic gray scale sonography with a newly developed sonographic contrast medium as a means of guidance for percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography. METHODS: We examined 85 patients with 108 hepatocellular carcinoma lesions that were identified as hypervascular by multidetector-row computed tomography by using contrast-enhanced harmonic gray scale sonography after injection of Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent. We scanned the whole liver by this modality at a low mechanical index in the late phase to detect lesions not detected by conventional sonography and then scanned the lesions again by this modality at a high mechanical index to visualize tumor vessels and enhancement. We also performed percutaneous ablation therapy guided by this modality to treat viable hepatocellular carcinoma lesions that could not be detected by conventional sonography. RESULTS: Conventional sonography identified 90 (83%) of 108 hepatocellular carcinoma lesions; 15 (14%) additional viable lesions not detected by conventional sonography were detected in the late phase of contrast-enhanced harmonic gray scale sonography at a low mechanical index, and tumor vessels and enhancement were observed in the late phase at a high mechanical index. Contrast-enhanced harmonic gray scale sonography diagnosed 105 (97%) of the 108 viable hepatocellular carcinoma lesions, and 14 (93%) of the 15 lesions not detected by conventional sonography were successfully treated by percutaneous ablation therapy guided by this modality. CONCLUSIONS: Contrast-enhanced harmonic gray scale sonography is useful for guidance of percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.     

Comparison of contrast-enhanced power Doppler ultrasound (Levovist) and computed tomography in alveolar echinococcosis

Background To date, no study has compared unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound with three-phase helical computed tomography (CT) for the analysis of the vascularization of hepatic lesions in patients who have alveolar echinococcosis.Methods Fifteen patients (11 female and four male; average age, 45.8 years) with confirmed Echinococcus multilocularis infection underwent unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound (2- to 5-MHz transducer head) and three-phase helical CT. The largest identified lesion in each patient was studied.Results CT visualized vascularization peripheral or central to the largest echinococcal lesions in 11 of 15 patients. Vascularization in the area of the echinococcal lesions was not visualized by unenhanced or contrast-enhanced power Doppler ultrasound in any of the 15 patients studied.Conclusion Three-phase helical CT visualizes the vascularization associated with Echinococcus multilocularis lesions in the liver. Neither unenhanced nor contrast-enhanced ultrasound in power mode is suitable for this application.     

Contrast-enhanced, wide-band harmonic gray scale imaging of hepatocellular carcinoma: correlation with helical computed tomographic findings.

We evaluated the usefulness of contrast-enhanced, wide-band harmonic gray scale imaging for the diagnosis of hepatocellular carcinoma and compared it with helical computed tomography. Forty-eight patients with 61 hepatocellular carcinoma lesions were scanned by contrast-enhanced, wide-band harmonic gray scale imaging after an intravenous bolus injection of the contrast agent Levovist. Fifty-seven of the 61 hepatocellular carcinoma lesions showed hypervascular enhancement, and intratumoral vessels could be observed in 40 of the 57 lesions. Helical computed tomography revealed a high-attenuation area in 54 of the 61 lesions, whereas the other lesions showed an equivocal-attenuation area. Contrast-enhanced, wide-band harmonic gray scale imaging is a useful method for diagnosing the vascularity of hepatocellular carcinoma.     

Utility of contrast-enhanced endoscopic ultrasonography for diagnosis of small pancreatic carcinomas

The aim of our study was to assess the utility of endoscopic ultrasonography (EUS) and contrast-enhanced EUS (CE-EUS) for the depiction and differential diagnosis of pancreatic tumors focusing in particularly those 2 cm or smaller. We compared different diagnostic procedures, contrast-enhanced multidetector computed tomography (CE-CT) and EUS with the use of power Doppler (PD-EUS) and CE-EUS for detection and differential diagnosis of pancreatic tumors. The study included 156 consecutive patients with suspected pancreatic tumors, who underwent CE-CT, and EUS followed by PD-EUS and CE-EUS. CE-EUS was performed by power Doppler mode using sonographic contrast agent Levovist. Thirty-six of 156 patients examined had tumors of < or =2 cm. EUS had significantly higher sensitivity (94.4%) for detection of pancreatic carcinomas of 2 cm or less in comparison to CE-CT (50%). For small pancreatic tumor of 2 cm or less, sensitivities for differentiating ductal carcinomas from other tumors were 50.0%, 11.0% and 83.3% for CE-CT, PD-EUS and CE-EUS. CE-EUS was significantly more sensitive than PD-EUS and CE-CT. EUS and subsequent CE-EUS are more sensitive than CE-CT in the detection and the differentiation of small pancreatic tumors.     

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.     

The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy.

OBJECTIVE: The purpose of this study was to evaluate the use of contrast-enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA). METHODS: One hundred seventy-nine patients with HCC were divided into 2 groups before receiving RFA: a CEUS group and a control group. The patients were concatenated and alternately apportioned into these 2 groups. In the CEUS group, 92 patients underwent pre-RFA CEUS using the contrast agent sulfur hexafluoride and enhanced computed tomography or magnetic resonance imaging before RFA for selecting suitable cases for RFA, and in the control group, conventional ultrasonography and enhanced computed tomography or magnetic resonance imaging were performed in 87 patients for selecting patients. RESULTS: In the CEUS group, 9 patients (9.8%) were excluded for RFA therapy by CEUS. The other 83 patients (90.2%), with a total of 114 lesions, were treated by RFA. In the control group, 5 patients (5.7%) were excluded for RFA. The other 82 patients (94.3%), with a total of 107 lesions, were treated by RFA. During the follow-up period of 18 to 50 months, the primary technique effectiveness rates in the CEUS and control groups were 94.7% and 87.9%, respectively (P = .1182). The local tumor progression rate, the new HCC rate, and the repeated RFA rate of the CEUS group were significantly lower than those of the control group (P = .033, .004, and .001, respectively). CONCLUSIONS: Pre-RFA CEUS provides important information for selecting suitable patients for RFA. The use of CEUS in selecting patients with HCC can decrease post-RFA local tumor progression and improve the efficacy of RFA therapy.     

肝肿瘤动态灰阶超声造影和增强CT表现的比较研究

目的　比较动态灰阶超声造影和增强CT显示肝肿瘤血流信号的特点。方法　对 49例病理证实的肝内实质性占位病变 (原发性肝癌 2 8例 ,肝血管瘤 9例和肝局灶性结节增生 12例 )进行超声造影和增强CT检查 ,比较两种影像技术在注射造影剂后不同时相的增强表现。结果　超声造影显示原发性肝癌中 85.7% (2 4/ 2 8)的肿块增强早于肝实质 ,门脉相和延迟相则多呈低回声 ;与增强CT显示 84.0 %(2 1/ 2 5)的肿瘤动脉期高密度、门脉期多呈低密度相一致。血管瘤中 67.7% (6/ 9)在超声造影的动脉相无明显增强 ,尔后逐渐向内部填充 ;与CT显示的造影剂逐渐填充呈结节状强化极为相似。肝局灶性结节增生在超声造影和增强CT上均显示早期快速增强 ,而消退较慢。 3种肿瘤在超声造影和增强CT不同时相的增强情况比较差异无显著性意义 (χ2 检验 ,P >0 .0 5)。结论　动态灰阶超声造影和增强CT都能敏感地显示不同肝肿瘤的血供特征 ,为肝肿瘤的鉴别诊断提供依据     

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.     

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.