Luo Wen, Numata Kazushi, Kondo Masaaki, Morimoto Manabu, Sugimori Kazuya, Hirasawa Kingo, Nozaki Akito, Zhou Xiaodong, Tanaka Katsuaki
Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan.
J Ultrasound Med. 2009 Apr;28(4):439-48. doi: 10.7863/jum.2009.28.4.439.
The purpose of this study was to evaluate the enhancement patterns of focal liver tumors in the late phase of Sonazoid-enhanced ultrasonography by intermittent imaging with a high mechanical index (MI).
A total of 142 patients with 208 lesions, including 109 hepatocellular carcinomas (HCCs), 61 metastases, 30 hemangiomas, and 8 focal nodular hyperplasias (FNHs), were enrolled in this prospective study. Contrast-enhanced ultrasonography with intermittent scanning at 2 frames per second (MI, 0.7-1.2) was conducted in the late phase (>5 minutes after bolus intravenous injection of the perflubutane-based contrast agent Sonazoid; Daiichi Sankyo, Tokyo, Japan). Two blinded readers classified the enhancement patterns of the lesions. The sensitivity, specificity, and positive predictive value (PPV) of the dominant enhancement patterns and inter-reader agreement were assessed.
A combination of diffuse enhancement with intratumoral vessels and intratumoral vessels alone yielded sensitivity of 85% (average of both readers), specificity of 88%, and a PPV of 88% for HCC. For metastasis, a combination of peripheral ringlike enhancement with peritumoral vessels and peripheral ringlike enhancement with intratumoral vessels yielded sensitivity of 79%, specificity of 95%, and a PPV of 85%. For hemangiomas, a combination of peripheral nodular enhancement with peritumoral vessels and peripheral nodular enhancement without peritumoral vessels yielded sensitivity of 75%, specificity of 99%, and a PPV of 92%. Diffuse enhancement with spoked wheel arteries yielded sensitivity of 82%, specificity of 100%, and a PPV of 87% for FNHs. Good inter-reader agreement was achieved.
Sonazoid-enhanced ultrasonography using intermittent imaging with a high MI can potentially be used for evaluating the enhancement patterns of focal liver tumors in the late phase.
本研究旨在通过高机械指数（MI）间歇性成像评估索拉佐德增强超声检查晚期肝局灶性肿瘤的增强模式。
本前瞻性研究纳入了142例患者的208个病灶，其中包括109例肝细胞癌（HCC）、61例转移瘤、30例血管瘤和8例局灶性结节性增生（FNH）。在晚期（静脉推注基于全氟丁烷的造影剂索拉佐德（日本东京第一三共株式会社生产）后>5分钟）进行每秒2帧（MI，0.7 - 1.2）的间歇性扫描的超声造影检查。两名盲法阅片者对病灶的增强模式进行分类。评估主要增强模式的敏感性、特异性和阳性预测值（PPV）以及阅片者间的一致性。
弥漫性增强伴瘤内血管和单纯瘤内血管相结合，对HCC的敏感性为85%（两位阅片者的平均值），特异性为88%，PPV为88%。对于转移瘤，外周环状增强伴瘤周血管和外周环状增强伴瘤内血管相结合，敏感性为79%，特异性为95%，PPV为85%。对于血管瘤，外周结节状增强伴瘤周血管和外周结节状增强不伴瘤周血管相结合，敏感性为75%，特异性为99%，PPV为92%。辐条样动脉的弥漫性增强对FNH的敏感性为82%，特异性为100%，PPV为87%。阅片者间一致性良好。
使用高MI间歇性成像的索拉佐德增强超声检查可能可用于评估晚期肝局灶性肿瘤的增强模式。
