Koito K, Namieno T, Morita K
Department of Radiology, Sapporo Medical University, Japan.
AJR Am J Roentgenol. 1998 Jan;170(1):157-61. doi: 10.2214/ajr.170.1.9423624.
The aim of this study was to compare the ability of power Doppler sonography and color Doppler sonography to differentiate hepatocellular carcinoma (HCC) from adenomatous hyperplasia (AH).
In 48 patients with cirrhosis of the liver, color Doppler sonography and power Doppler sonography were performed on 53 hepatic nodules smaller than 20 mm in diameter (32 nodules were HCC; 21 nodules were AH). We evaluated the detectability of the pulsatile and continuous flows in the nodules at each hepatic segment.
Thirty-four percent of nodules produced color signal on color Doppler sonography; 77%, on power Doppler sonography (p < .01). The identification rate of nodules in the left lateral segment was significantly lower than in other segments. Continuous flow was seen in the nodules of both HCC and AH. However, only in HCC did we see pulsatile flow. For HCC, pulsatile flow was seen with color Doppler sonography in 25% of the nodules smaller than 10 mm in diameter and in 50% of the nodules between 10 and 20 mm. With power Doppler sonography, pulsatile flow was seen in 67% (p < .05) of the nodules smaller than 10 mm and in 90% (p < .01) of the nodules between 10 and 20 mm. Sensitivity and negative predictive value in the differentiation of HCC from AH were significantly higher with power Doppler sonography than with color Doppler sonography (81% versus 41%, respectively, for sensitivity and 78% versus 53%, respectively, for negative predictive value). Specificity, positive predictive value, and efficacy of both color Doppler sonography and power Doppler sonography were 100%, 100%, 60%, respectively.
On the basis of our results, power Doppler sonography is more sensitive than color Doppler sonography in revealing small HCC and in differentiating HCC from AH under physiologic hemodynamic conditions.
本研究旨在比较能量多普勒超声和彩色多普勒超声鉴别肝细胞癌（HCC）与腺瘤样增生（AH）的能力。
对48例肝硬化患者直径小于20mm的53个肝结节进行彩色多普勒超声和能量多普勒超声检查（32个结节为HCC；21个结节为AH）。我们评估了每个肝段结节内搏动性血流和连续性血流的可检测性。
彩色多普勒超声检查时34%的结节产生彩色信号；能量多普勒超声检查时为77%（p<0.01）。肝左外叶结节的识别率显著低于其他肝段。HCC和AH结节内均可见连续性血流。然而，仅在HCC中可见搏动性血流。对于HCC，直径小于10mm的结节中25%在彩色多普勒超声检查时可见搏动性血流，直径在10至20mm之间的结节中50%可见。在能量多普勒超声检查时，直径小于10mm的结节中67%（p<0.05）可见搏动性血流，直径在10至20mm之间的结节中90%（p<0.01）可见。能量多普勒超声在鉴别HCC与AH时的敏感性和阴性预测值显著高于彩色多普勒超声（敏感性分别为81%和41%，阴性预测值分别为78%和53%）。彩色多普勒超声和能量多普勒超声的特异性、阳性预测值和效能分别为100%、100%、60%。
根据我们的研究结果，在生理血流动力学条件下，能量多普勒超声在发现小HCC及鉴别HCC与AH方面比彩色多普勒超声更敏感。
