Evaluation of the vascular architecture of hepatocellular carcinoma by micro flow imaging: pathologic correlation.
OBJECTIVE
The purpose of this study was to evaluate micro flow imaging (MFI) in depicting the vascular architecture of hepatocellular carcinoma (HCC) and the correlation between pathologic differentiation and the intratumoral vascular architecture pattern.


METHODS
Micro flow imaging and contrast harmonic imaging (CHI) were performed in 37 patients with HCC. A sulfur hexafluoride-filled microbubble contrast agent was used. The enhancement level and intratumoral vessels were evaluated on CHI. The vascular architecture of each tumor was evaluated on MFI. Pathologic differentiation of the tumors was classified according to the Edmondson grading system.


RESULTS
All 37 HCCs showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases on CHI. Intratumoral vessels in the arterial phase were visualized in 20 (54.1%) HCCs. On MFI, the vascular architecture in all lesions was clearly delineated and categorized into 3 patterns: cotton, shrubbery, and deadwood, identified in 12 (32.4%), 22 (59.5%), and 3 (8.1%) of the tumors evaluated, respectively. A chi(2) test showed that pathologic differentiation significantly correlated to the vascular pattern (P = .006). Three (75%) of 4 Edmondson grade I HCCs showed the cotton pattern; 18 (75.0%) of 24 Edmondson grade II HCCs showed the shrubbery pattern; and the deadwood pattern was shown only in Edmondson grade III and IV HCCs.


CONCLUSIONS
The MFI technique is more effective in depicting the intratumoral vascular architecture. The vascular architecture pattern correlates with pathologic differentiation of HCC.
Yang
Hong
H
Departments of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Liu
Guang-Jian
GJ
Lu
Ming-De
MD
Xu
Hui-Xiong
HX
Xie
Xiao-Yan
XY
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride