Sonographic characteristics of small hepatocellular carcinoma

Fifty-four lesions of small hepatocellular carcinoma under 5 cm in diameter detected by real-time sonography were reviewed to characterize the sonographic feature. Twenty-nine lesions were smaller than 3 cm in diameter and 25 were between 3 and 5 cm in diameter. Sonographic characteristics of hepatocellular carcinoma were peripheral hypoechoic halo (52%), lateral shadow (26%), posterior acoustic enhancement (44%), and mosaic pattern (24%) of the mass. Small tumors less than 3 cm in diameter showed a hypoechoic pattern in half of the cases, whereas most of the tumors between 3 and 5 cm in diameter showed a hyperechoic or mixed pattern. Posterior acoustic enhancement was commonly seen in small tumors less than 3 cm in diameter, while a mosaic pattern was commonly seen in large tumors between 3 and 5 cm in diameter. These results suggest that sonography might be useful for the characterization of small hepatocellular carcinoma.     

Hepatocellular carcinoma with or without cirrhosis: A comparison of CT and angiographic presentations in the United States and Japan

We compared the computed tomographic (CT) and angiographic presentations of hepatocellular carcinoma (HCC) with or without cirrhosis in the United States and Japan. Tumors in the United States were advanced and less frequently associated with liver cirrhosis (association of cirrhosis: United States) 56.2%, Japan 91.0%. In patients with cirrhosis, the size of the tumor tended to be smaller, and nodular tumors (single or multiple) were frequent. In early stage of HCCs with cirrhosis, tumors were hypovascular without a capsule. In advanced stage, tumors were hypervascular and a capsule was frequently observed around the tumor both with CT and angiography. HCCs without cirrhosis were seen in younger patients. These tumors were large at the time of diagnosis. A massive or diffuse mass without a capsule was frequently seen. Most tumors were hypodense on precontrast CT and hypervascular on angiography. Lymph node enlargement was significantly frequent. The radiological characteristics of HCC in both countries were significantly different depending upon associated cirrhosis, as well as the time of the diagnosis.     

Combined hepatocellular and cholangiocarcinoma of the liver: Sonography,CT, Angiography,and Iodized-Oil CT with pathologic correlation

To evaluate the characteristics of combined hepatocellular and cholangiocarcinoma of the liver by imaging techniques, six patients (five male and one female), aged 46–60 years, with proved combined tumors were selected for this study from the review of 500 resected specimens of liver tumors. Images obtained from sonography, computed tomography (CT), angiography, and CT after intraarterial injection of iodized oil (iodized-oil CT) were retrospectively reviewed and correlated with the appearance of pathologic specimens. Sonographic findings were round or ovoid hypoechoic masses with central hyperechoic area (target appearance) in all patients. On CT scans, tumors were relatively well-defined low- and/or iso-attenuation masses in all patients. Angiography showed hypovascular masses in five patients. In one patient, the tumor appeared as a hypovascular mass with a central hypervascular area. On iodized-oil CT scans, all patients showed partial retention of iodized oil in tumors. Echogenicity in tumors at sonography or attenuation in tumors at CT could not be correlated with histologic difference in tumors at pathologic specimens. However, the hypervascular area at angiography and the compact retention areas of iodized oil at iodized-oil CT corresponded to portions of hepatocellular carcinoma within the combined tumor. On the basis of our results, imaging features, including target appearance at sonography, hypovascular mass with central hypervascular portions at angiography, and partial retention of iodized oil in tumors at iodized-oil CT, might be helpful in making accurate diagnosis of these rare tumors.     

Value of Intraoperative Sonography in Pancreatic Surgery

The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease. 1 ^– 8 Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care—the surgeon's scalpel—can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures.     

Nonpathological focal enhancements on spiral CT hepatic angiography

Background: To assess the frequency and characteristics of nonpathological focal enhancements seen on spiral computed tomographic (CT) hepatic angiography (CTA). Methods: Spiral CTA and spiral CT arterial portography (CTAP) were performed in 31 patients with suspected liver malignancy prior to potential liver resection. The CTA images were retrospectively reviewed for focal enhancements by two radiologists. After determining nonpathological focal enhancements on CTA images based on the other radiographic tests, surgical exploration including intraoperative sonography, follow-up imagings, the frequency, size, site, and shape of nonpathological focal enhancements with CTA were assessed. Results: Thirty-six nonpathological focal enhancements with CTA from 4 to 23 (mean = 11.4) mm were seen in 14 (45.2%) of 31 patients. Thirteen (36.1%) of 36 nonpathological focal enhancements with CTA were not depicted with CTAP. Nonpathological focal enhancements with CTA were frequent in Couinaud segments III (27.8%), V (22.2%), and VI (19.4%). Twenty-three (63.9%) of 36 nonpathological focal enhancements were located in the edge of the liver. Shapes of 36 nonpathological focal enhancements with CTA included circular (n = 16), worm (n = 7), irregular (n = 6), dot (n = 6), and wedge (n = 1). Conclusion: In nearly half of patients, spiral CTA shows various shapes of small nonpathological focal enhancements more frequently in the liver edge. Received: 6 June 1996/Accepted: 14 July 1996     

Gray scale second harmonic imaging of acoustic emission signals improves detection of liver tumors in rabbits.

This study evaluates a new reticuloendothelium specific sonographic contrast agent NC100100 (Sonazoid) for detection of liver VX-2 tumors in rabbits. Gray scale imaging of five groups of three rabbits, with hepatic VX-2 tumors implanted 7, 10, 12, 14, and 18 days previously, was performed prior to injection of Sonazoid (dosages, 0.01-0.5 ml/kg). Sonazoid produces induced acoustic emission after uptake in the liver. Therefore, harmonic gray scale images were obtained immediately after injection as well as delayed (by up to 2(1/2) h). Five rabbits (one from each group) also had angiography performed, while all animals were evaluated by pathologic examination. Non-contrast enhanced sonography detected 17 of 61 tumors (29%), as well as three false-positives, while the addition of Sonazoid detected 57 tumors (93%) and one false-positive (P<0.001). Acoustic emission made 2 x 2 mm tumors (invisible in conventional B-mode sonography) clearly perceivable in harmonic gray scale. In the subgroup that received angiography, 12 of 36 tumors (33%) were detected with conventional sonography compared to 22 tumors (61%) seen with angiography (P = 0.002). After injection of Sonazoid the ultrasonographic detection rate increased to 97% (35 of 36 tumors), which was a significant improvement over angiography (P = 0.00024). Improved detection of hepatic VX-2 tumors with second harmonic gray scale imaging of Sonazoid is possible because of this agent's acoustic emission capabilities.     

Imaging of gastrointestinal neuroendocrine tumors

Gastrointestinal neuroendocrine tumors are rare neoplasms that cause classic clinical syndromes because of the excess secretion of specific gastrointestinal hormones. The two most important tumors clinically are insulinomas and gastrinomas. The clinical management of patients with these disorders usually involves the localization and surgical removal of the responsible tumor. Many radiological techniques can be used for tumor localization, including preoperative and intraoperative ultrasound, endoscopic ultrasound, CT, MRI, radionuclide scanning, angiography, and venous sampling. However, there are conflicting claims as to the relative accuracy of these procedures, and many of these investigations are difficult to justify because of their high cost, degree of invasiveness, or lack of precise anatomic information that is obtained. If surgical resection of a neuroendocrine tumor is planned, intraoperative sonography should always be used to detect occult nonpalpable tumors and to discern the relationship of the tumor to vital adjacent pancreatic ductal anatomy. The choice of preoperative imaging is more controversial, and depends on the clinical problem, local expertise, and availability of imaging techniques. Sonography and contrast-enhanced helical CT are the most commonly used preoperative imaging methods, because of their relatively low cost and widespread availability. Radionuclide scanning with a somatostatin analogue, which is a relatively new procedure, may be valuable in patients with symptoms of tumor recurrence.     

Evaluation of hepatocellular carcinoma after treatment with transcatheter arterial chemoembolization: comparison of Lipiodol-CT, power Doppler sonography, and dynamic MRI

BACKGROUND: The purpose of this study was to compare the ability of Lipiodol-computed tomography (CT), power Doppler (PD) sonography, and dynamic magnetic resonance imaging (MRI) in evaluating the therapeutic effect of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC). METHODS: TACE was performed by injecting an emulsion consisting of Lipiodol and a chemotherapeutic drug, followed by gelatin sponge particles, into 54 patients with 84 HCC lesions. Five to 7 days later, Lipiodol-CT, PD sonography, and dynamic MRI were performed. Findings from the three modalities were correlated with relapse within 1 year after TACE. RESULTS: All lesions with blood flow on PD sonography or intratumoral enhancement on dynamic MRI relapsed regardless of the findings with Lipiodol-CT. None of the negatively enhanced lesions on dynamic MRI relapsed regardless of the Lipiodol-CT findings. However, the readers could not evaluate the contrast uptake in 14 lesions that were already hyperintense on the precontrast images. These cases were considered unsuitable for qualitative assessment and reduced the applicability of MRI to 83% of the examined lesions (70 of 84). Although PD sonography perfectly predicted relapse in superficial (0-5 cm from abdominal surface) lesions of the right hepatic lobe, blood flow in deep (>5 cm) or left lobe lesions was undetectable regardless of the occurrence of relapse. As a result, Lipiodol-CT displayed 76.0% sensitivity, 67.6% specificity, and 72.6% accuracy. The sensitivity, specificity, and accuracy of PD sonography were 34.0%, 100%, and 60.7%, respectively. In the 70 lesions in which evaluation was possible, dynamic MRI achieved 100% sensitivity, 100% specificity, and 100% accuracy. CONCLUSION: Of the three modalities, dynamic MRI was the best for evaluating the efficacy of TACE in the treatment of HCC. We also found that superficial lesions of the right lobe are good candidates for PD sonography. However, high signals on precontrast MR images, motion artifacts, and ultrasonic attenuation remain key limitations.     

术前及术中超声、CT及术中触诊诊断肝肿瘤的一致性评价

目的 评价术前超声、CT及术中超声、术中触诊诊断肝肿瘤良恶性的一致性.方法 分析70例肝肿瘤患者的术前超声、术前CT检查、术中超声以及术中触诊结果,对四种检查结果与病理及随访结果诊断肝肿瘤良恶性的一致性进行评价.结果 术前超声与病理及随访结果诊断肝肿瘤良恶性的一致性为中等(Kappa值0.63),术中触诊与病理及随访结果的诊断一致性较低(Kappa值0.38),CT以及术中超声检查与病理及随访结果诊断一致性较高(Kappa值分别为0.71及0.89),而术中超声与CT检查之间诊断一致性也较高(Kappa值为0.53).而术前超声与术中超声以及术前超声与术中触诊之间诊断一致性均较低(Kappa值均为0.23).结论 在肝肿瘤诊断评价中,CT与术中超声具有较高的诊断一致性,虽然术前超声与术中触诊诊断结果一致性较低,但在临床工作中依然不可或缺,而若能将四者结合应用,将有助于肝肿瘤的诊断与治疗.     

Diagnostic accuracy of sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions

PURPOSE: The aim of this study was to assess the diagnostic accuracy of sonography alone and combined sonographic assessment and sonographically guided fine-needle aspiration cytology in solid, nonpalpable lesions of the breast. METHODS: We retrospectively evaluated the sonograms from a series of 174 consecutive nonpalpable masses that were cytologically diagnosed using fine-needle aspiration under sonographic guidance and then histologically verified through surgical excision. We examined the relationships between the findings from sonography, combined sonographic assessment and cytopathology, and histology. RESULTS: Histologically, 95 lesions (55%) were malignant and 79 (45%) were benign. The overall sensitivity of sonography alone for diagnosing cancer was 98. 9% (94 of 95 lesions), and the specificity was 45.6% (36 of 79 lesions). One (3%) of 37 masses considered at sonography to be benign was correctly diagnosed on cytologic examination to be cancer. By establishing the benign status of 11 of 13 masses that were indeterminate at sonography, cytology increased the specificity of the combined method (to 56.3%). Cytology appropriately suspected or confirmed malignancy in 79 (84%) of 94 carcinomas considered at sonography to be suspicious or malignant. CONCLUSIONS: In this study, sonography alone demonstrated a high sensitivity but limited specificity in evaluating nonpalpable breast masses. The addition of sonographically guided cytology substantially increased the specificity of the combined method without compromising sensitivity.     

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。     

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.     

原发性胆囊癌的彩色多普勒超声诊断

目的 探讨原发性胆囊癌术前应用彩色多普勒超声检查的临床价值。方法 对照手术及病理诊断,回顾性总结了36例术前超声拟诊为胆囊癌患者的超声资料,分析原发性胆囊癌及其他易误诊为胆囊癌疾病的二维超声及彩色多普勒超声影像学特点。结果 术后病理证实胆囊癌30例（83．3％）,其他胆囊疾病6例（16．7％）。二维超声可以观察到胆囊占位的形态、大小,与肝脏的分界情况,并能观察有无肝脏转移、淋巴结肿大及胆管扩张等异常声像;彩色多普勒不仅可以评价占位病变内血供情况,为鉴别诊断提供重要的资料,还可以对门静脉有无侵犯进行初步评估。结论 综合应用二维超声与彩色多普勒超声进行术前检查,有助于原发性胆囊癌的鉴别诊断,并判断肿瘤与周围组织的关系,对治疗方案的制定有重要意义。     

Brenner tumors of the ovary: sonographic and computed tomographic imaging features.

OBJECTIVE: The purpose of this study was to describe the sonographic appearance of ovarian Brenner tumors with computed tomographic (CT) correlation. METHODS: Twenty-two female patients (age range, 32-78 years; mean, 58 years) with 25 ovarian Brenner tumors were identified from pathologic records from 1990 to 2005. Corresponding pathologic reports and images (17 sonographic and 14 CT) were reviewed independently. RESULTS: Tumors ranged in size from 0.3 to 12 cm (mean, 2.5 cm); all were benign. Sixteen (64%) of 25 were found incidentally. Eight (36%) of 22 patients had a total of 12 associated benign ovarian neoplasms (1 was contralateral); 3 patients had bilateral Brenner tumors. Eight (47%) of 17 tumors were not seen on sonography, and 5 (36%) of 14 were not seen on CT. Of the tumors seen on imaging, most were solid (67% on sonography and 78% on CT). Four tumors appeared at least partially cystic, of which 3 had coexistent cystic ovarian lesions. CONCLUSIONS: Brenner tumors are most often solid neoplasms found incidentally and frequently seen in association with other benign ovarian epithelial neoplasms.     

Assessment of the therapeutic response of hepatocellular carcinoma treated with transcatheter arterial chemoembolization: comparison of contrast-enhanced sonography and 3-phase computed tomography.

OBJECTIVE: The purpose of this study was to compare contrast-enhanced sonography with 3-phase computed tomography (CT) in assessing the therapeutic response of hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization (TACE). METHODS: Twenty-nine nodular HCCs treated with TACE were examined with contrast-enhanced sonography, 3-phase helical CT, and conventional angiography. Contrast-enhanced sonographic and CT findings were interpreted separately and prospectively for the presence or absence of contrast enhancement in the treated HCCs. Conventional angiography served as the reference standard. RESULTS: Intratumoral enhancement was seen in 19 HCCs (61%) on contrast-enhanced sonography and 12 HCCs (39%) on CT. Enhancement patterns on sonography were blush in 8 (42%), branching in 2 (11%), nodular in 4 (21%), and stippled in 5 (26%). Of the 19 HCCs with intratumoral enhancement on contrast-enhanced sonography, 13 (68%) showed tumor staining on angiography. Of the 12 HCCs without intratumoral enhancement on sonography, 1 (8%) showed tumor staining on angiography. The sensitivity and specificity of contrast-enhanced sonography in depicting flow in HCCs treated with TACE were 93% and 65%, respectively. The sensitivity and specificity of 3-phase CT were 64% and 100%. CONCLUSIONS: Contrast-enhanced sonography is a more sensitive imaging method than 3-phase CT in depicting vascularity in HCCs treated with TACE.     

Hepatic intraarterial lipiodol: Technique,semiologic patterns,and value for hepatic tumors

Hepatic intraarterial lipiodol (HIAL) coupled with computed tomography (CT) was used in a homogeneous series of 138 cases. All patients received 10 ml lipiodol emulsion injected by an arterial route; there were no serious complications. Four semiologic patterns were observed. Aside from nodular regenerative hyperplasia occurring in the absence of cirrhosis, HIAL gave no false-positive indications of tumor, as demonstrated by a series of 20 patients with uncomplicated cirrhosis evaluated for over 12 months. Comparison of ultrasonography, CT, angiography, and HIAL coupled with CT for exploration of hepatomas revealed the marked superiority of HIAL/CT for both tumor detection and lesion localization (search for daughter tumors).     

Comparison of computed tomography and magnetic resonance imaging in the evaluation of focal hepatic lesions

Two combined magnetic resonance (MR) spin-echo pulse sequences at 0.35 T were compared with dynamic bolus contrast-enhanced computed tomography (CT) in the evaluation of focal hepatic lesions. Each combined MR sequence was performed in a separate group of patients. The first group consisted of 76 patients in whom a moderately T1-weighted sequence (spin echo [SE] 500/30 [repetition time/echo time]) was combined with a T2-weighted sequence (SE 2000/60). In the second group, consisting of 68 patients, a more heavily T1-weighted sequence (SE 250/15) was combined with the T2-weighted sequence. All studies were evaluated in a retrospective blinded fashion, with construction of receiver operating characteristic curves.We conclude that, in detection of patients with one or more focal hepatic lesions, either combined MR sequence was comparable to CT. In the detection of individual hepatic lesions, the sensitivity of the combined MR sequence with a moderately T1-weighted sequence (SE 500/30 and 2000/60) was essentially equivalent to CT (79 vs 77%, respectively). Additionally, a combined MR sequence with a heavily T1-weighted pulse sequence (SE 250/15 and 2000/60) was not statistically different than CT (86 vs 80%, respectively). These findings were supported by the receiver operating characteristic analysis.     

实时谐波超声造影在肝肿瘤消融治疗中的应用

目的探讨实时谐波超声造影在肝肿瘤消融治疗中的价值。方法对112例肝脏局灶性占位病变患者进行实时超声谐波造影、增强CT/MR和/或病理检查。34例进行了手术治疗,32例进行了射频消融治疗。结果实时谐波超声造影诊断肝脏恶性肿瘤的敏感性、特异性和准确性分别为97.1%、95.3%和96.4%。超声造影显示病灶数增加,病灶范围增大;射频消融后10min和1个月超声造影分别有5例和3例患者见动脉早期病灶部分强化。病灶最大直径超声造影测值与手术标本测值无差异。结论超声造影有助于肝脏肿瘤非手术治疗适应证的选择,提高引导穿刺的准确性和确定治疗范围,以及术后疗效监测。     

壶腹部癌B超与CT诊断对照分析

目的：探讨B超与CT对壶腹部癌的术前诊断价值。方法：回顾性分析了21例同期进行B超及CT检查的壶腹部癌患者,所有病例均经手术衣病理证实,结果：B超定位诊断正确率为85．7％（18／21）,CT定位诊断正确率为38．1％（8／21）,结论：在壶腹部癌的定位诊断方法,B超优于CT,如果B超与CTP必切结合则会提高诊断正确率。     

Intraoperative spinal sonography in the evaluation of intramedullary tumors

Seventeen intraoperative spinal sonographic examinations were performed in 14 patients with intramedullary spinal cord neoplasms. Results of the ultrasound exams were correlated with preoperative imaging studies, surgical findings, and histopathologic analysis of the tumors. Intraoperative spinal sonography accurately localized the intramedullary tumors, often revealing the need for extension of the initial laminectomy. The neoplasms appeared as expansile echogenic masses, with cystic components in over half. Ultrasound was as accurate as preoperative imaging in the evaluation of solid neoplasms, and was superior to computed tomography (CT) and magnetic resonance imaging (MRI) for delineating the cystic components of neoplasms. Intraoperative sonography should be used routinely in all surgical cases of intramedullary spinal cord neoplasms.