Fujimoto M, Moriyasu F, Nishikawa K, Nada T, Okuma M
First Department of Internal Medicine, Kyoto University, Japan.
AJR Am J Roentgenol. 1994 Nov;163(5):1099-104. doi: 10.2214/ajr.163.5.7976882.
The purpose of this study was to evaluate the clinical usefulness of a galactose-based, IV sonographic contrast agent for assessing tumor vascularity and diagnosing hepatocellular carcinoma.
We used color Doppler sonography with the sonographic contrast agent to examine 22 patients with 26 hepatic nodules (18 hepatocellular carcinomas, four hemangiomas, two adenomatous hyperplasias, and two metastatic tumors). In all 26 lesions, intratumoral arterial flow signals were examined before and after IV injection of the sonographic contrast agent at three concentrations (200, 300, and 400 mg/ml), and the findings on color Doppler sonograms of each lesion were correlated with angiographic findings.
Conventional color Doppler sonograms showed flow in nine hepatocellular carcinomas (50%) and one hemangioma (25%). When the contrast agent was used, color Doppler sonograms showed intratumoral arterial flow in 11 hepatocellular carcinomas (61%) and one hemangioma (25%) at a concentration of 200 mg/ml, in 14 hepatocellular carcinomas (78%) and 1 hemangioma (25%) at 300 mg/ml, and in 15 hepatocellular carcinomas (83%) and two hemangiomas (50%) at 400 mg/ml. The detectability of intratumoral arterial flow was improved by the contrast agent, especially in hepatocellular carcinomas smaller than 30 mm in diameter. Angiography revealed neovascularization or staining in 15 hepatocellular carcinomas, four hemangiomas, and none of the adenomatous hyperplasias or metastatic tumors. Among 15 angiographically hypervascular hepatocellular carcinomas, the detection rate of intratumoral arterial flow with contrast-enhanced color Doppler sonography was 73% at 200 mg/ml, 93% at 300 mg/ml, and 100% at 400 mg/ml. No intratumoral Doppler signals were depicted with the use of contrast agent in any angiographically undetected tumors.
Preliminary findings on contrast-enhanced color Doppler sonograms correlate well with angiographic findings for evaluating tumor vascularity. This noninvasive technique may be useful in diagnosing hypervascular hepatocellular carcinomas.
本研究旨在评估一种基于半乳糖的静脉超声造影剂在评估肿瘤血管生成及诊断肝细胞癌方面的临床应用价值。
我们对22例患有26个肝结节（18例肝细胞癌、4例血管瘤、2例腺瘤样增生及2例转移瘤）的患者使用彩色多普勒超声及超声造影剂进行检查。在所有26个病灶中，静脉注射三种浓度（200、300和400mg/ml）的超声造影剂前后均对瘤内动脉血流信号进行检查，并将每个病灶的彩色多普勒超声检查结果与血管造影结果进行对比。
常规彩色多普勒超声显示9例肝细胞癌（50%）和1例血管瘤（25%）有血流信号。使用造影剂时，彩色多普勒超声显示，在200mg/ml浓度下，11例肝细胞癌（61%）和1例血管瘤（25%）有瘤内动脉血流信号；在300mg/ml浓度下，14例肝细胞癌（78%）和1例血管瘤（25%）有瘤内动脉血流信号；在400mg/ml浓度下，15例肝细胞癌（83%）和2例血管瘤（50%）有瘤内动脉血流信号。造影剂提高了瘤内动脉血流信号的检出率，尤其是对于直径小于30mm的肝细胞癌。血管造影显示15例肝细胞癌、4例血管瘤有新生血管或染色，而腺瘤样增生及转移瘤均无此表现。在15例血管造影显示为高血供的肝细胞癌中，在200mg/ml浓度下，超声造影增强彩色多普勒超声对瘤内动脉血流信号的检出率为73%，在300mg/ml浓度下为93%，在400mg/ml浓度下为100%。在血管造影未检出的肿瘤中，使用造影剂均未显示瘤内多普勒信号。
超声造影增强彩色多普勒超声的初步检查结果与血管造影在评估肿瘤血管生成方面的结果具有良好的相关性。这种非侵入性技术可能有助于诊断高血供肝细胞癌。
