title: Evaluation of primary malignancies of the liver using contrast-enhanced sonography: correlation with pathology.
abstract: OBJECTIVE
  Our purpose was to investigate the correlation of contrast-enhanced sonographic patterns with the histopathology of primary malignancies of the liver.
  
  
  METHODS
  Of the 318 contrast-enhanced sonographic examinations performed between April and September 2004, 95 patients with 117 lesions confirmed by surgery or biopsy pathology were reviewed in this study. We analyzed the enhancement time and patterns according to the types and degrees of pathologic differentiation.
  
  
  RESULTS
  All 65 moderately to poorly differentiated hepatocellular carcinomas (HCCs) enhanced in the arterial phase, and 96.9% (63 lesions) of them quickly washed out in the portal venous phase. All 32 well-differentiated HCCs enhanced in the arterial phase, and 50.0% (16 lesions) washed out slowly during the late phase. The washout time of the two differentiated types was significantly different (p < 0.05). Seventy-five percent of the clear cell carcinomas (12/16) enhanced in the arterial phase, 25% (4/16) did not enhance until the portal venous phase, and 31.3% (5/16) of the clear cell carcinomas washed out slowly during the late phase. The enhancement and washout times of clear cell carcinomas were significantly different than those of moderately to poorly differentiated HCCs (p < 0.05). All four intrahepatic cholangiocarcinomas presented the same patterns as moderately to poorly differentiated HCCs: enhanced in the arterial phase and quickly washed out in the portal venous phase. Among the 72 lesions enhanced homogeneously, 46 lesions (63.9%) were smaller than 3 cm. Thirty-seven lesions (82.2%) of the 45 lesions that enhanced heterogeneously were larger than 3 cm (including the four cholangiocarcinomas). Larger lesions were mainly less differentiated. There were significant differences in tumor sizes in regard to cellular differentiations and types.
  
  
  CONCLUSIONS
  Our study showed that the enhancement manifestations of primary malignancies of the liver are related to pathologic types and grades. Contrast-enhanced sonograms may provide the histopathologic information for malignant tumors of the liver.
authors.affiliation: Department of Ultrasound, School of Oncology, Peking University, 52 Fu-cheng Rd., Beijing 100036, People's Republic of China.
authors.forename: Zhi-Hui
authors.initials: ZH
authors.lastname: Fan
authors.forename: Min-Hua
authors.initials: MH
authors.lastname: Chen
authors.forename: Ying
authors.initials: Y
authors.lastname: Dai
authors.forename: Yan-Bin
authors.initials: YB
authors.lastname: Wang
authors.forename: Kun
authors.initials: K
authors.lastname: Yan
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Yin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride