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Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI

  • ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
  • Published:
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Abstract

Background

Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC.

Methods

Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively.

Results

On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P < 0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P < 0.001).

Conclusions

In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.

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Abbreviations

DN:

Dysplastic nodule

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl diethylenetriamine

GRE:

Gradient echo

HCC:

Hepatocellular carcinoma

LAVA:

Liver acquisition with volume acceleration

OATP8:

Organic anion transporting polypeptide 8

SEUS:

Sonazoid-enhanced ultrasonography

SPIO:

Superparamagnetic iron oxide

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka, 563-8510, Japan

    Hideko Ohama, Yasuharu Imai, Sachiyo Kogita, Yoshiyuki Sawai, Takumi Igura, Kazuto Fukuda & Yuki Makino

  2. Department of Clinical Laboratory Medicine, Kurume University School of Medicine, Kurume, Japan

    Osamu Nakashima

  3. Department of Radiology, Ikeda Municipal Hospital, Osaka, Japan

    Manabu Takamura & Yasushi Seki

  4. Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan

    Masatoshi Hori

  5. Department of Surgery, Ikeda Municipal Hospital, Osaka, Japan

    Osakuni Morimoto

  6. Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan

    Masahiko Ohsawa

  7. Department of Pathology, Keio University School of Medicine, Tokyo, Japan

    Michiie Sakamoto

  8. Department of Radiology, Faculty of Medicine, Kinki University, Osaka, Japan

    Takamichi Murakami

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  1. Hideko Ohama
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  2. Yasuharu Imai
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  8. Yoshiyuki Sawai
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  9. Takumi Igura
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  12. Osakuni Morimoto
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  13. Masahiko Ohsawa
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Correspondence to Yasuharu Imai.

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Ohama, H., Imai, Y., Nakashima, O. et al. Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI. J Gastroenterol 49, 1081–1093 (2014). https://doi.org/10.1007/s00535-013-0859-1

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  • DOI: https://doi.org/10.1007/s00535-013-0859-1

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