title: Hyperenhanced Rim Surrounding Liver Metastatic Tumors in the Postvascular Phase of Sonazoid-Enhanced Ultrasonography: A Histological Indication of the Presence of Kupffer Cells.
abstract: OBJECTIVE
  A hyperenhanced rim (termed 'HER') in the postvascular phase is detected in some cases of liver metastasis by Sonazoid-enhanced ultrasonography (US). Here, the association of the HER with histological features was investigated to clarify the cause of this characteristic imaging pattern.
  
  
  METHODS
  A total of 13 hepatic nodules obtained from 11 patients with metastatic liver cancer who underwent Sonazoid-enhanced US followed by surgical resection were analyzed. The distribution density of CD68-positive cells in the tumor rim and the nontumor area was calculated and compared between the HER-positive and HER-negative groups. The relation between the pathological features of the tumor rim and the rate of necrosis within the tumor was also investigated.
  
  
  RESULTS
  In the HER-positive group (n = 8), the distribution density of CD68-positive cells was 2.9 ± 0.9, which was significantly higher than that (1.0 ± 0.3) in the HER-negative group (p < 0.05). Inflammatory cell infiltrates, including CD8-positive lymphocytes, were detected in all the HER-positive cases in the area surrounding the tumor, while fibrosis was observed in all the HER-negative cases. The necrotic area within the tumor was significantly larger in the HER-negative group.
  
  
  CONCLUSIONS
  The HER-positive sign in liver metastases could reflect an increase in Kupffer cells in the tumor rim. The presence of the HER was associated with inflammatory cell infiltrates including CD8-positive lymphocytes surrounding the metastatic liver tumor.
authors.affiliation: Department of Clinical Laboratory, Kobe City General Hospital, Kobe, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tochio
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sugahara
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tei
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Suginoshita
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Imawsaki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sasaki
authors.forename: Michio
authors.initials: M
authors.lastname: Hamada
authors.forename: Kazushi
authors.initials: K
authors.lastname: Minowa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Inokuma
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D005290:Ferric Compounds / Q000493:pharmacokinetics*; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007501:Iron / Q000493:pharmacokinetics*; D007728:Kupffer Cells / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010087:Oxides / Q000493:pharmacokinetics*; D011379:Prognosis; D014018:Tissue Distribution; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron