title: New malignant grading system for hepatocellular carcinoma using the Sonazoid contrast agent for ultrasonography.
abstract: BACKGROUND
  The ultrasonography contrast agent Sonazoid provides parenchyma-specific contrast imaging (Kupffer imaging) based on its accumulation in Kupffer cells. This agent also facilitates imaging of the fine vascular architecture in tumors through maximum intensity projection (MIP). We examined the clinical utility of the malignancy grading system for hepatocellular carcinoma (HCC) using a combination of 2 different contrast-enhanced ultrasonography images.
  
  
  METHODS
  We studied 121 histologically confirmed cases of HCC (well-differentiated, 45; moderately differentiated, 70; poorly differentiated, 6). The results of Kupffer imaging were classified as (1) iso-echoic pattern or (2) hypo-echoic pattern. The MIP patterns produced were classified into one of the following categories: fine, tumor vessels were not clearly visualized and only fine vessels were visualized; vascular, tumor vessels were visualized clearly; irregular, tumor vessels were thick and irregular. Based on the combined assessment of Kupffer imaging and the MIP pattern, the samples were classified into 4 grades: Grade 1 (iso-fine/vascular), Grade 2 (hypo-fine), Grade 3 (hypo-vascular), and Grade 4 (hypo-irregular).
  
  
  RESULTS
  The distribution of moderately and poorly differentiated HCCs was as follows: Grade 1, 4 % (1/24); Grade 2, 52 % (15/29); Grade 3, 85 % (44/52); and Grade 4, 100 % (16/16). The grading system also predicted portal vein invasion in 72 resected HCCs: Grade 1, 0 % (0/4); Grade 2, 13 % (1/8); Grade 3, 23 % (11/48); and Grade 4, 67 % (8/12).
  
  
  CONCLUSIONS
  This new malignant grading system is useful for estimation of histological differentiation and portal vein invasion of HCC.
authors.affiliation: Ultrasound Imaging Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan, hironori@hyo-med.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iijima
authors.forename: Akiko
authors.initials: A
authors.lastname: Higashiura
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yoh
authors.forename: Akio
authors.initials: A
authors.lastname: Ishii
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takashima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sakai
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Aizawa
authors.forename: Kazunari
authors.initials: K
authors.lastname: Iwata
authors.forename: Naoto
authors.initials: N
authors.lastname: Ikeda
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Iwata
authors.forename: Hirayuki
authors.initials: H
authors.lastname: Enomoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Saito
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Imanishi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirota
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujimoto
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishiguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D007728:Kupffer Cells / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D010087:Oxides; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D016037:Single-Blind Method; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron