title: Use of vessel patterns on contrast-enhanced ultrasonography using a perflubutane-based contrast agent for the differential diagnosis of regenerative nodules from early hepatocellular carcinoma or high-grade dysplastic nodules in patients with chronic liver disease.
abstract: OBJECTIVE
  We evaluated the use of tumor vessel patterns observed during arterial-phase contrast-enhanced ultrasonography (US) to differentiate regenerative nodules (RN) from early hepatocellular carcinoma (HCC) or high-grade dysplastic nodules (HGDN) in patients with chronic liver disease.
  
  
  METHODS
  Pathologically confirmed lesions (83 early HCC, 6 HGDN, and 13 RN with mean maximal diameters of 15.4, 15.3, and 16.2 mm, respectively) were enrolled in this retrospective study. We performed contrast-enhanced US using a perflubutane-based contrast agent. We then classified the tumor vessels observed during the arterial phase of contrast-enhanced US into two patterns: peripheral vessels (centripetal pattern) and central vessels (centrifugal pattern).
  
  
  RESULTS
  Eighty-one (97.6%) of the 83 early HCC exhibited various enhancement patterns (hypovascular, 44.6%; isovascular, 25.3%; and hypervascular, 27.7%) and a peripheral vessel pattern, while the remaining 2 lesions (2.4%) exhibited hypovascular enhancement and a central vessel pattern. All 6 HGDN lesions were hypovascular with a peripheral vessel pattern. Twelve (92.3%) of the 13 RN were hypovascular with a central vessel pattern, and the remaining one (7.7%) was hypervascular with a central vessel pattern. When lesions exhibiting a central vessel pattern during arterial-phase contrast-enhanced US were diagnosed as RN, the sensitivity, specificity, and accuracy of these diagnoses were 100%, 97.8%, and 98.0%, respectively.
  
  
  CONCLUSIONS
  The tumor vessel patterns observed during arterial-phase contrast-enhanced US may be useful for differentiating RN from early HCC or HGDN in patients with chronic liver disease.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. kz-numa@urahp.yokohama-cu.ac.jp.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. fukuhiro@yokohama-cu.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. h.n.twopines@gmail.com.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nihonmatsu
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. mkondou@urahp.yokohama-cu.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. akino@urahp.yokohama-cu.ac.jp.
authors.forename: Akito
authors.initials: A
authors.lastname: Nozaki
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. chuma@yokohama-cu.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Chuma
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. m-morimoto@kcch.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. ohshimatakashi@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Department of Radiology, University Hospital of the Ryukyus, 207 Azakamihara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan. okada777@med.u-ryukyu.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Okada
authors.affiliation: Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan. murakami@med.kindai.ac.jp.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Radiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. take2922@urahp.yokohama-cu.ac.jp.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Takebayashi
authors.affiliation: Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. smaeda@med.yokohama-cu.ac.jp.
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
authors.affiliation: Department of Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. inayama@yokohama-cu.ac.jp.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inayama
authors.affiliation: Pathological Department, Shonan Fujisawa Tokusyukai Hospital, 1-5-1 Kamidai, Tusjido, Fujisawa, Kanagawa, 251-0041, Japan. m-nakano@ctmc.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. k_tanaka@urahp.yokohama-cu.ac.jp.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D002908:Chronic Disease; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D007089:Image Enhancement; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C108042:perfluorobutane
keywords: Contrast-enhanced ultrasonography; Early hepatocellular carcinoma; High-grade dysplastic nodule; Regenerative nodule; Tumor vessel