Contrast-enhanced ultrasonography findings using a perflubutane-based contrast agent in patients with early hepatocellular carcinoma

Eur J Radiol. 2014 Jan;83(1):95-102. doi: 10.1016/j.ejrad.2013.09.025. Epub 2013 Oct 6.

Abstract

Objective: We evaluated the contrast-enhanced ultrasonography (US) imaging features of early hepatocellular carcinomas (HCCs) and compared these findings with those obtained using contrast-enhanced computed tomography (CT).

Subjects and methods: Forty-three patients with 52 early HCCs with a mean maximal diameter of 15.6mm were enrolled in this retrospective study. After confirming the location of the target lesion using fusion imaging combining conventional US and hepatobiliary phase of contrast-enhanced magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid, we evaluated findings of contrast-enhanced US using a perflubutane-based contrast agent. The contrast-enhanced US detection rates for hyper-vascularity in early HCCs were compared with those obtained for contrast-enhanced CT.

Results: Transient hypo-vascularity subsequent to iso-vascularity during arterial phase and iso-vascularity during portal and post-vascular phases were the predominant contrast-enhanced US findings seen for 25 (48.1%) of the 52 early HCCs. Nine (17.3%) showed iso-vascularity during all three phases, while 1 (1.9%) showed hypo-vascularity during all three phases. The remaining 17 (32.7%) showed partial or whole hyper-vascularity during arterial phase, iso-vascularity during portal phase, and iso- or hypo-vascularity during post-vascular phase. The detection rate for the hyper-vascularity of early HCCs using contrast-enhanced US (32.7%, 17/52) was significantly higher than that obtained using contrast-enhanced CT (21.2%, 11/52) (P<0.05 by McNemar test).

Conclusion: Hypo-vascularity, iso-vascularity, and hyper-vascularity were observed during the arterial phase of contrast-enhanced US in 50.0%, 17.3%, and 32.7% of the early HCCs, respectively. Contrast-enhanced US was more sensitive than contrast-enhanced CT for the detection of hyper-vascularity in early HCCs. Of note, early HCCs might not exhibit the early arterial enhancement that is generally considered to be a typical finding for HCCs.

Keywords: Contrast-enhanced CT; Contrast-enhanced ultrasonography; Early hepatocellular carcinoma; Vascularity.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnosis*
  • Contrast Media
  • Early Detection of Cancer / methods*
  • Female
  • Ferric Compounds*
  • Gadolinium DTPA
  • Humans
  • Image Enhancement / methods
  • Iron*
  • Liver Neoplasms / diagnosis*
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Neovascularization, Pathologic / diagnosis*
  • Oxides*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*
  • Ultrasonography / methods*

Substances

  • Contrast Media
  • Ferric Compounds
  • Oxides
  • Sonazoid
  • gadolinium ethoxybenzyl DTPA
  • Iron
  • Gadolinium DTPA