title: Arrival time parametric imaging using Sonazoid-enhanced ultrasonography is useful for the detection of spoke-wheel patterns of focal nodular hyperplasia smaller than 3 cm.
abstract: It is considered difficult to make a definitive diagnosis of focal nodular hyperplasia (FNH) of <3 cm when using conventional diagnostic imaging modalities. Typical FNH imaging findings are: i) central scar formation, ii) nutrient vessels extending radially from the center and iii) the presence of Kupffer cells. In a clinical setting, identification of a spoke-wheel pattern formed by nutrient vessels extending radially is a key feature in the diagnosis of FNH. In this study, we investigated the detection rate of spoke-wheel patterns of FNH <3 cm using arrival time parametric imaging (At-PI) technology with Sonazoid-enhanced ultrasonography (US). Five patients with FNH <3 cm who had undergone Sonazoid-enhanced US at the Toho University Omori Medical Center between February 2008 and March 2009 were included in the study. The mean tumor diameter was 20.2±7.2 mm. Lesions were enhanced with 0.5 ml Sonazoid US contrast agent and a video of the procedure was saved and used for At-PI analysis of contrast agent dynamics in FNH. Three ultrasonographic specialists examined the images and made a diagnosis of FNH based on the findings of spoke-wheel patterns. Similarly, micro-flow imaging (MFI) was performed to evaluate the contrast agent dynamics in FNH. Using MFI, FNH was diagnosed in 3 of the 5 cases by the three specialists, whereas At-PI enabled the identification of spoke-wheel patterns in all 5 cases. At-PI using Sonazoid-enhanced US is superior for detecting spoke-wheel patterns of FNH <3 cm.
authors.affiliation: Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo 143-8541;
authors.forename: Noritaka
authors.initials: N
authors.lastname: Wakui
authors.forename: Ryuji
authors.initials: R
authors.lastname: Takayama
authors.forename: Naohisa
authors.initials: N
authors.lastname: Kamiyama
authors.forename: Kojiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Daigo
authors.initials: D
authors.lastname: Matsui
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsukiyo
authors.forename: Takenori
authors.initials: T
authors.lastname: Kanekawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikehara
authors.forename: Koji
authors.initials: K
authors.lastname: Ishii
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
keywords: Sonazoid; arrival time parametric imaging; contrast-enhanced ultrasonography; focal nodular hyperplasia; micro-flow imaging; spoke-wheel pattern