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DOI: 10.1055/s-2005-858518
© Georg Thieme Verlag KG Stuttgart · New York
Contrast-Enhanced Sonography for the Characterisation of Hepatocellular Carcinomas - Correlation with Histological Differentiation
Kontrastmittelverstärkte Sonographie bei der Charakterisierung von heptozellulären Karzinomen - Korrelation mit dem histologischen DifferenzierungsgradPublikationsverlauf
received: 10.7.2005
accepted: 25.7.2005
Publikationsdatum:
26. August 2005 (online)
![](https://www.thieme-connect.de/media/ultraschall/200504/lookinside/thumbnails/10.1055-s-2005-858518-1.jpg)
Abstract
Aim: We aimed to characterise the vascularisation patterns of hepatocellular carcinomas in contrast-enhanced sonography in correlation to the histological differentiation of hepatocellular carcinomas (HCC), and we also compared the diagnostic value of contrast-enhanced sonography in addition to B-scan sonography and power Doppler sonography. Methods: 51 hepatocellular carcinomas (21 well differentiated, 27 moderately differentiated, 3 poorly differentiated) were examined: by B-scan sonography, power Doppler sonography and contrast-enhanced sonography using phase or pulse inversion harmonic imaging with a low mechanical index(< 0.3) and second generation microbubble contrast medium (Optison®, Sonovue®) as echo-enhancing agent. Lesion vascularity and the kinetics of contrast enhancement within the lesions in the early arterial phase, arterial phase, portal phase and late phase were analysed. The final diagnosis of a HCC was assessed after B-scan sonography, power Doppler sonography and contrast-enhanced sonography. Results: Hypervascularisation and/or irregular tumour vascularisation could be detected in 18/48 HCCs (37.5 %) by power Doppler sonography. After contrast application, 46/51 HCCs (90.2 %) were identified as hyperechoic lesions during the early arterial or arterial phase with no correlation to histological differentiation. In the portal phase and late phase, the echogenicity of HCCs after contrast application was variable. A hypoechoic appearance was noted in 17/51 HCCs (33.3 %) in the portal phase and in 21/51 HCCs (41.2 %) in the late phase. Moderately differentiated HCCs were more often hypoechoic than well differentiated HCCs (p = 0.04). Conclusion: Contrast-enhanced sonography is highly efficient for the detection of tumour vascularity in HCCs. The majority of HCCs - regardless of histological differentiation - can be characterised as hypervascular lesions in the early arterial and arterial phase with irregular tumour vessels using contrast-enhanced sonography. In addition to B-scan sonomorphology, contrast-enhanced sonography may offer helpful information in patients with liver cirrhosis and focal liver lesions.
Zusammenfassung
Ziel: Beschreibung des Vaskularisationsmusters von Karzinomen der Leber bei der kontrastmittelverstärkten Sonographie in Korrelation zum histologischen Differenzierungsgrad dieser hepatozellulären Karzinome (HCC). Der diagnostische Nutzen der Kontrastmittel-Sonographie als Ergänzung zu B-Bild-Sonographie und Power-Doppler-Sonographie wurde ebenfalls untersucht. Methode: Untersucht wurden 51 hepatozelluläre Karzinome (21 gut differenzierte, 27 mäßig differenzierte, 3 undifferenzierte) mittels B-mode-Sonographie, Power-Doppler-Sonographie und kontrastmittelverstärkter Sonographie mit Phasen- oder Puls-Inversions-Technik mit niedrigem mechanischem Index (< 0,3). Kontrastmedium waren die Kontrastmittel der zweiten Generation, Optison® und Sonovue®. Vaskularisierung der Lebertumoren sowie die Kinetik der Kontrastverstärkung innerhalb der Läsionen während der frühen arteriellen Phase, der arteriellen, portalvenösen und der späten Phase wurden analysiert. Die endgültige Diagnose „HCC” wurde nach der Auswertung von B-Bild-Sonographie, Power-Doppler- und kontrastmittelverstärkter Sonographie gestellt. Ergebnisse: Hypervaskularisation und/oder irreguläre Vaskularisierung der Tumoren wurde bei 18/48 hepatozellulären Karzinomen (HCC) durch Power-Doppler festgestellt. Nach Kontrastmittelapplikation konnten 46/51 HCC als echoreiche Läsionen in der frühen arteriellen oder der arteriellen Phase identifiziert werden. Eine Korrelation zum histologischen Differenzierungsgrad wurde hierbei nicht festgestellt. In der portalvenösen und der späten Phase nach Kontrastmittelgabe war die Echogenität der Karzinome uneinheitlich. Bei 17/51 (33,3 %) der hepatozellulären Karzinome fand sich ein echoarmes Muster in der portalvenösen Phase, bei 21/51 (41,2 %) in der späten Phase. Mäßig differenzierte HCC waren häufiger echoarm als gut differenzierte (p = 0,04). Schlussfolgerung: Die kontrastmittelverstärkte Sonographie ist eine hocheffiziente Methode zur Feststellung der Vaskularisation von hepatozellulären Karzinomen. Die Mehrzahl der HCC zeigt sich bei dieser Untersuchung typischerweise als in der früharteriellen und der arteriellen Phase hypervaskularisierte Tumoren mit einem unregelmäßigen Verteilungsmuster der Tumorgefäße. Dieser Befund steht nicht in Beziehung zum histologischen Differenzierungsgrad. Als Ergänzung zur B-Bild-Sonomorphologie kann die kontrastmittelverstärkte Sonographie nützliche Informationen bei Patienten mit Leberzirrhose und fokalen Leberveränderungen bieten.
Key words
Contrast-enhanced sonography - hepatocellular carcinoma - ultrasound contrast agent - phase inversion harmonic imaging - low mechanical index - second generation ultrasound contrast media - Sonovue® - Optison® - liver cirrhosis
Schlüsselwörter
Kontrastmittelverstärkte Sonographie - hepatozelluläres Karzinom - Ultraschallkontrastmittel - Phaseninversionstechnik - niedriger mechanischer Index - Ultraschallkontrastmittel der zweiten Generation - Sonovue® - Optison® - Leberzirrhose
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Deike Strobel, M.D.
Department of Medicine I, Division of ultrasound diagnostics, Friedrich-Alexander University of Erlangen-Nuernberg
Ulmenweg 18
91054 Erlangen
Telefon: ++49/91 31/8 53 52 61
Fax: ++49/91 31/8 53 52 52
eMail: deike.strobel@med1.imed.uni-erlangen.de