title: Heterogeneity of microbubble accumulation: a novel approach to discriminate between well-differentiated hepatocellular carcinomas and regenerative nodules.
abstract: This prospective study aimed to elucidate the possibility of differentiating well-differentiated hepatocellular carcinoma (wHCC) from regenerative nodule (RN) on the basis of the heterogeneity of microbubble accumulation. Intensity analysis was conducted on early-phase and late-phase (60 s and 900 s post-injection; perflubutane microbubble) harmonic sonograms in 33 focal hepatic lesions (≤ 15 mm; 30 patients with chronic liver disease) that were histologically proven as wHCC or RN. Heterogeneity of enhancement, an average of standard deviation of late-phase enhancement in three different sections in the lesions with late-phase iso-enhancement, was examined with respect to the histologic findings. Heterogeneity of enhancement was higher in wHCC (28.7 ± 3.8) than RN (19.8 ± 2.1, p = 0.0213) in the 29 late-phase iso-enhancement lesions. The best cut-off value of the heterogeneity for the diagnosis of wHCC was 25.58, and the sensitivity and specificity were 77.8% and 100%, respectively. A novel parameter, heterogeneity of microbubble accumulation, facilitates differentiation between wHCC and RN showing a late-phase, iso-enhancement appearance.
authors.affiliation: Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan. maru-cib@umin.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Takahashi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sekimoto
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kamesaki
authors.forename: Taro
authors.initials: T
authors.lastname: Shimada
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kanai
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D002454:Cell Differentiation; D003287:Contrast Media / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D005260:Female; D005290:Ferric Compounds / Q000493:pharmacokinetics*; D006801:Humans; D007501:Iron / Q000493:pharmacokinetics*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D008115:Liver Regeneration / Q000502:physiology; D008297:Male; D008657:Metabolic Clearance Rate; D045423:Microbubbles; D008875:Middle Aged; D010087:Oxides / Q000493:pharmacokinetics*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014018:Tissue Distribution; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron