title: Usefulness of Sonazoid contrast-enhanced ultrasonography for hepatocellular carcinoma: comparison with pathological diagnosis and superparamagnetic iron oxide magnetic resonance images.
abstract: OBJECTIVE
  We investigated the usefulness of Sonazoid contrast-enhanced ultrasonography (Sonazoid-CEUS) in the diagnosis of hepatocellular carcinoma (HCC). The examination was performed by comparing the images during the Kupffer phase of Sonazoid-CEUS with superparamagnetic iron oxide magnetic resonance (SPIO-MRI).
  
  
  METHODS
  The subjects were 48 HCC nodules which were histologically diagnosed (well-differentiated HCC, n=13; moderately differentiated HCC, n=30; poorly differentiated HCC, n=5). We performed Sonazoid-CEUS and SPIO-MRI on all subjects. In the Kupffer phase of Sonazoid-CEUS, the differences in the contrast agent uptake between the tumorous and non-tumorous areas were quantified as the Kupffer phase ratio and compared. In the SPIO-MRI, it was quantified as the SPIO-intensity index. We then compared these results with the histological differentiation of HCCs.
  
  
  RESULTS
  The Kupffer phase ratio decreased as the HCCs became less differentiated (P<0.0001; Kruskal-Wallis test). The SPIO-intensity index also decreased as HCCs became less differentiated (P<0.0001). A positive correlation was found between the Kupffer phase ratio and the SPIO-MRI index (r=0.839). In the Kupffer phase of Sonazoid-CEUS, all of the moderately and poorly differentiated HCCs appeared hypoechoic and were detected as a perfusion defect, whereas the majority (9 of 13 cases, 69.2%) of the well-differentiated HCCs had an isoechoic pattern. The Kupffer phase images of Sonazoid-CEUS and SPIO-MRI matched perfectly (100%) in all of the moderately and poorly differentiated HCCs.
  
  
  CONCLUSIONS
  Sonazoid-CEUS is useful for estimating histological grading of HCCs. It is a modality that could potentially replace SPIO-MRI.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan. keikore@med.kawasaki-m.ac.jp
authors.forename: Keiko
authors.initials: K
authors.lastname: Korenaga
authors.forename: Masaaki
authors.initials: M
authors.lastname: Korenaga
authors.forename: Matakazu
authors.initials: M
authors.lastname: Furukawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007089:Image Enhancement; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010087:Oxides; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; C000499:ferric oxide; D007501:Iron