Yamamoto Kouji, Shiraki Katsuya, Nakanishi Shigeo, Fuke Hiroyuki, Nakano Takeshi, Hashimoto Akira, Shimizu Atsuya, Hamataki Toshinobu
First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
World J Gastroenterol. 2005 Sep 28;11(36):5607-13. doi: 10.3748/wjg.v11.i36.5607.
To investigate the usefulness of 1.5 Harmonic Imaging Sonography with the use of the contrast agent Levovist for the diagnosis of hepatocellular carcinoma (HCC) and for the evaluation of therapeutic response.
Phantom experiments were performed to compare the contrast effects of 2(nd) harmonic imaging and 1.5 Harmonic Imaging Sonography. 1.5 Harmonic Imaging Sonography was employed to examine 36 patients with HCC (42 nodules) before and after the treatment and to compare against the findings obtained using other diagnostic imaging modalities.
In 1.5 Harmonic Imaging Sonography, the tumor vessels of HCCs were clearly identified during the early phase, and late-phase images clearly demonstrated the differences in contrast enhancement between the tumor and surrounding hepatic parenchyma. Blood flow within the tumor was detected in 36 nodules (85.7%) during the early phase and in all 42 nodules (100%) during the late phase using 1.5 Harmonic Imaging Sonography, in 38 nodules (90.5%) using contrast-enhanced CT, in 34 nodules (81.0%) using digital subtraction angiography (DSA), and in 42 nodules (100%) using US CO(2) angiography. Following transcatheter arterial embolization, 1.5 Harmonic Imaging Sonography detected blood flow and contrast enhancement within the tumors that were judged to contain viable tissue in 20 of 42 nodules (47.6%). However, 6 of these 10 cases were not judged in contrast-enhanced CT. 1.5 Harmonic Imaging Sonography was compared with the US CO(2) angiography findings as the gold standard, and the sensitivity and specificity of these images for discerning viable and nonviable HCC after transcatheter arterial embolization were 100% and 100%, respectively.
1.5 Harmonic Imaging Sonography permits the vascular structures of HCCs to be identified and blood flow within the tumor to be clearly demonstrated. Furthermore, 1.5 Harmonic Imaging Sonography is potentially useful for evaluating the therapeutic effects of transcatheter arterial embolization on HCC.
探讨使用造影剂声诺维的1.5谐波成像超声在肝细胞癌（HCC）诊断及治疗反应评估中的应用价值。
进行体模实验以比较二次谐波成像与1.5谐波成像超声的造影效果。采用1.5谐波成像超声对36例HCC患者（42个结节）治疗前后进行检查，并与其他诊断成像方式的检查结果进行比较。
在1.5谐波成像超声检查中，HCC的肿瘤血管在早期清晰可见，晚期图像清楚地显示了肿瘤与周围肝实质之间的造影剂增强差异。使用1.5谐波成像超声时，36个结节（85.7%）在早期检测到肿瘤内血流，42个结节（100%）在晚期检测到肿瘤内血流；使用增强CT时，38个结节（90.5%）检测到肿瘤内血流；使用数字减影血管造影（DSA）时，34个结节（81.0%）检测到肿瘤内血流；使用超声二氧化碳血管造影时，42个结节（100%）检测到肿瘤内血流。经导管动脉栓塞术后，1.5谐波成像超声在42个结节中的20个（47.6%）检测到被判断为含有存活组织的肿瘤内血流及造影剂增强。然而，这10例中的6例在增强CT检查中未被判断出来。以超声二氧化碳血管造影结果作为金标准，比较1.5谐波成像超声，这些图像在经导管动脉栓塞术后辨别存活与非存活HCC的敏感性和特异性分别为100%和100%。
1.5谐波成像超声能够识别HCC的血管结构并清晰显示肿瘤内血流。此外，1.5谐波成像超声在评估经导管动脉栓塞术对HCC的治疗效果方面可能具有应用价值。
