Differential diagnosis of hepatic tumors: value of contrast-enhanced harmonic sonography using the newly developed contrast agent, Sonazoid.
OBJECTIVE
To clarify the value of contrast-enhanced harmonic ultrasonography (US) with Sonazoid, a second-generation US contrast agent, in the differential diagnosis of liver tumors compared to dynamic CT.


METHODS
A total of 249 hepatic nodules in 214 patients were studied; these included 177 hepatocellular carcinomas (HCCs), 42 liver metastases, 20 liver hemangiomas, 6 dysplastic nodules and 4 focal nodular hyperplasias (FNHs). After the injection of Sonazoid, nodules were scanned using real-time contrast-enhanced harmonic US in the vascular phases, i.e. the early and late vascular phases, and the Kupffer phase.


RESULTS
Six enhancement patterns were identified to be significant for the differential diagnosis of hepatic tumors. In HCCs, the presence of intratumoral vessels supplied from the periphery and fast washout (sensitivity, 96.6%; specificity, 94.4%) were the most typical characteristics. In metastases, the presence of rim-like enhancement with peripheral tumor vessels (sensitivity, 88.1%; specificity, 100%) was the typical pattern. In hemangiomas, the presence of intratumoral hypoperfusion images with globular or cotton wool-like pooling, which continue to the late vascular phase (sensitivity, 90.0%; specificity, 99.6%), was typical. In dysplastic nodules, the presence of portal enhancement without arterial supply in the early vascular phase and the presence of intratumoral uptake in the Kupffer phase (sensitivity, 83.3%; specificity, 100%) were the most typical patterns. In FNHs, the presence of a spoke-wheel pattern in the early vascular phase with dense staining in the late vascular phase, and positive uptake within the nodule in the Kupffer phase (sensitivity, 100%; specificity, 100%) were the most typical patterns.


CONCLUSIONS
Contrast-enhanced harmonic US with Sonazoid allowed intimate vascular and Kupffer imaging and, therefore, is useful for the differential diagnosis of hepatic tumors.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan.
Kinuyo
K
Hatanaka
Masatoshi
M
Kudo
Yasunori
Y
Minami
Taisuke
T
Ueda
Chie
C
Tatsumi
Satoshi
S
Kitai
Shunsuke
S
Takahashi
Tatsuo
T
Inoue
Satoru
S
Hagiwara
Hobyung
H
Chung
Kazuomi
K
Ueshima
Kiyoshi
K
Maekawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007089:Image Enhancement; D007501:Iron; D007728:Kupffer Cells / Q000000981:diagnostic imaging / Q000473:pathology; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron