Detection of tumor vascularity in hepatocellular carcinoma with contrast-enhanced Dynamic Flow imaging: Comparison with contrast-enhanced power Doppler imaging.
OBJECTIVE
To compare the effectiveness of contrast-enhanced Dynamic Flow imaging and contrast-enhanced power Doppler imaging using Levovist(®) as a microbubble contrast agent in evaluating intratumoral vascularity in hepatocellular carcinoma (HCC).


METHODS
Twenty-nine patients with 54 hepatocellular carcinoma nodules (before treatment, 31; after treatment, 23) were studied with both Dynamic Flow and power Doppler imaging with intravenous injection of Levovist(®). Tumor vascularity was categorized as 0, no blood flow signals within the tumor; 1, dotlike blood flow signals within the tumor; 2, moderate blood flow signals within the tumor; and 3, abundant blood flow signals within the tumor. Detectability of intratumoral vascularity of hepatocellular carcinoma in three groups based on tumor depth, blooming and noise artifacts on contrast-enhanced Dynamic Flow and contrast-enhanced power Doppler imaging were also compared with results obtained using dynamic CT as a the gold standard. The effectiveness of contrast-enhanced Dynamic Flow and contrast-enhanced power Doppler imaging in assessing therapeutic effect were compared at the same time.


RESULTS
The ability of contrast-enhanced Dynamic Flow Doppler imaging to detect tumor vascularity in the superficial and intermediate hepatocellular carcinoma groups was close to that of contrast-enhanced power Doppler imaging (p>0.05). However, contrast-enhanced Dynamic Flow imaging demonstrated tumor parenchymal stain in 28 hepatocellular carcinoma nodules (61%), which was not detected by contrast-enhanced power Doppler imaging. Further, significantly fewer artifacts appeared in contrast-enhanced Dynamic Flow imaging than in contrast-enhanced power Doppler imaging (p<0.001). In assessing therapeutic response, the sensitivity of contrast-enhanced Dynamic Flow imaging was similar to that of dynamic CT. In deep areas, however, those more than 6 cm below the surface of the body, contrast-enhanced Dynamic Flow imaging was less sensitivity than contrast-enhanced power Doppler imaging (p=0.005).


CONCLUSIONS
Contrast-enhanced Dynamic Flow imaging provides an effective approach to assessing intratumoral vascularity and therapeutic response in HCC lesions situated less than 6 cm from the surface of the body. It is superior to contrast-enhanced power Doppler imaging in its ability to detect tumor parenchymal stain and production of fewer artifacts.
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.|Department of Ultrasound, Sun Yut-Sen University of Medical Science Memorial Hospital, 107 Yanjiangxi Road, 510120, Guangzhou, China.
Yan Ling
YL
Wen
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Masatoshi
M
Kudo
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Yasunori
Y
Minami
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Hobyung
H
Chung
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Yoichiro
Y
Suetomi
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Hirokazu
H
Onda
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Masayuki
M
Kitano
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Toshihiko
T
Kawasaki
Abdominal Ultrasound Unit, Kinki University School of Medicine, 377-2, 589-8511, Ohno-higashi, Japan.
Kiyoshi
K
Maekawa
contrast medium; hepatocellular carcinoma; liver neoplasm; power Doppler imaging; wide-band Doppler imaging