Usefulness of combination of imaging modalities in the diagnosis of hepatocellular carcinoma using Sonazoid®-enhanced ultrasound, gadolinium diethylene-triamine-pentaacetic acid-enhanced magnetic resonance imaging, and contrast-enhanced computed tomography.
OBJECTIVE
To clarify the diagnostic ability of combining imaging methods to diagnose hepatocellular carcinoma (HCC) using Sonazoid®-enhanced ultrasound (US), gadolinium diethylene-triamine-pentaacetic acid-enhanced (Gd-EOB-DTPA) magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CECT).


METHODS
A total of 32 patients who underwent surgical resection for HCC were studied. Sonazoid-enhanced US, Gd-EOB-DTPA MRI, CECT, and intraoperative contrast-enhanced ultrasonography were done for all patients. The definitive diagnosis of HCC in those patients was based on histopathological confirmation.


RESULTS
A total of 50 histologically proven HCCs were obtained from 32 patients; their mean (± SD) age was 68.3 years ± 8.1. The mean (± SD) nodule size was 2.6 cm ± 1.9. Twenty percent were well-differentiated HCC, 64% were moderately differentiated HCC, 10% were poorly differentiated HCC, 4% were combined HCC and CCC, and 2% were HCC with severe necrosis. The overall diagnostic sensitivity of CEUS, CECT, and Gd-EOB-DTPA MRI was 72, 74, and 86%, respectively; however, there was no significant difference between the three imaging modalities in diagnosing typical HCC (p = 0.092). When combining the diagnostic ability of the different imaging modalities, the diagnostic sensitivity of Sonazoid-enhanced US and Gd-EOB-DTPA MRI was 90%, while addition of Sonazoid-enhanced US to CECT and CECT to Gd-EOB-DTPA MRI had a sensitivity of 82 and 88%, respectively. There was no significant difference between the three imaging combinations (p = 0.970).


CONCLUSIONS
Sonazoid-enhanced US and Gd-EOB-DTPA MRI can be confidently used in daily clinical practice for the management of HCC.
Division of Gastoroenterology and Hepatology, Department of Internal Medicine, Kinki University Faculty of Medicine,  Osakasayama, Japan.
Alshimaa
A
Alaboudy
Tatsuo
T
Inoue
Kinuyo
K
Hatanaka
Hobyung
H
Chung
Tomoko
T
Hyodo
Seishi
S
Kumano
Takamichi
T
Murakami
Ehab Fawzy Abdou
EF
Moustafa
Masatoshi
M
Kudo
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005290:Ferric Compounds; D019786:Gadolinium DTPA; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010087:Oxides; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler
D014408:Biomarkers, Tumor; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron; D019786:Gadolinium DTPA