title: Correlation between microbubble contrast-enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: preliminary results.
abstract: OBJECTIVE
  The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist.
  
  
  METHODS
  Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings.
  
  
  RESULTS
  Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue.
  
  
  CONCLUSIONS
  Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.
authors.affiliation: First Department of Surgery, Shinsu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Kosei
authors.initials: K
authors.lastname: Nakajima
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Ota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D007728:Kupffer Cells / Q000166:cytology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508