A sub-centimeter HCC with bright loop appearance diagnosed by contrast-enhanced ultrasonography.
Detection of a hepatocellular carcinoma (HCC) in the early stage is critical, as clinical stage influences treatment selection and patient prognosis. Carcinogenetic development of an HCC is a multi-step process, and a differential diagnosis between a dysplastic nodule and a well-differentiated HCC is often difficult. A bright loop appearance is a significant finding that indicates disappearance of fatty deposition in the central area of the nodule during the progression toward HCC, however such a finding is rare in cases of sub-centimeter-sized HCCs. We encountered a case of HCC that developed a bright loop appearance on ultrasound (US) without enlargement approximately 2 years after diagnosis as a dysplastic nodule. Moreover, the hypoechoic area in the center of the nodule showed an HCC pattern in contrast enhanced US with Sonazoid™. Vascularity in the nodule could not be observed on dynamic contrast-enhanced CT or Gd-EOB-DTPA-enhanced MRI. When a change in the intranodular echo pattern is observed in sub-centimeter-sized nodules, examination of intranodular vascularity by contrast-enhanced US is important to evaluate borderline lesions.
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan. bbsato@med.shimane-u.ac.jp.
Shuichi
S
Sato
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Tatsuya
T
Miyake
Department of Clinical Examination, Shimane University Hospital, Izumo, Shimane, 693-8501, Japan.
Asako
A
Fukuma
Department of Clinical Examination, Shimane University Hospital, Izumo, Shimane, 693-8501, Japan.
Eri
E
Nitta
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Noritsugu
N
Yamashita
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Takuya
T
Hanaoka
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Junichi
J
Ishine
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Hiroshi
H
Tobita
Department of Medicine, Ooda City Hospital, 1428-3 Ooda, Ooda, Shimane, Japan.
Shuji
S
Akagi
Division of Gastrointestinal Endoscopy, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, Japan.
Yuji
Y
Amano
Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Yoshikazu
Y
Kinoshita
Bright loop appearance; Hepatocellular carcinoma; Sonazoid™; Ultrasonography