Journal of Gastroenterology

, Volume 40, Issue 12, pp 1139–1147 | Cite as

Differential diagnosis of nodular lesions in cirrhotic liver by post-vascular phase contrast-enhanced US with Levovist: comparison with superparamagnetic iron oxide magnetic resonance images

  • Tatsuo Inoue
  • Masatoshi Kudo
  • Ryousuke Watai
  • Zhou Pei
  • Toshihiko Kawasaki
  • Yasunori Minami
  • Hobyung Chung
  • Toyokazu Fukunaga
  • Kazuo Awai
  • Osamu Maenishi



We investigated the diagnostic utility of post-vascular phase contrast-enhanced ultrasonography (US) and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) as compared to the histological diagnosis of differential grades of hepatocellular carcinomas (HCCs).


Forty-nine patients with histologically characterized liver nodules (well-differentiated HCC, n = 20; moderately differentiated HCC, n = 19; poorly differentiated HCC, n = 1; dysplastic nodule, n = 9) received contrast-enhanced US and SPIO-MRI. Subsequently, we quantitatively evaluated the relationships between the images of the nodules and their histological diagnosis and differential grades.


The ratio of the echogenicity of the tumorous area to that of the nontumorous area with post-vascular phase contrast-enhanced US (post-vascular phase ratio) decreased as nodules became less differentiated (P < 0.05; Kruskal-Wallis test). The ratio of the intensity of the nontumorous area to that of the tumorous area on SPIO-enhanced MR images (SPIO intensity index) also decreased as nodules became less differentiated (P < 0.01). The post-vascular phase ratio correlated with the SPIO intensity index for HCCs and dysplastic nodules (r = 0.76). The conformity of the result from the post-vascular phase contrast-enhanced US and SPIO-MRI was 96%.


Contrast-enhanced US is a valuable method for predicting the histological grade of HCCs in cirrhotic patients, and may be a good alternative to SPIO-enhanced MRI.

Key words

contrast-enhanced ultrasonography post-vascular phase SPIO-MRI hepatocellular carcinoma dysplastic nodule 


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Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Tatsuo Inoue
    • 1
  • Masatoshi Kudo
    • 1
  • Ryousuke Watai
    • 2
  • Zhou Pei
    • 3
  • Toshihiko Kawasaki
    • 1
  • Yasunori Minami
    • 1
  • Hobyung Chung
    • 1
  • Toyokazu Fukunaga
    • 1
  • Kazuo Awai
    • 4
  • Osamu Maenishi
    • 5
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineKinki University School of MedicineJapan
  2. 2.Department of RadiologyKinki University School of MedicineOsakaJapan
  3. 3.Department of UltrasoundWuhan General Hospital of Guangzhou Military AreaWuhanChina
  4. 4.Department of Diagnostic RadiologyKumamoto University Graduate School of Medical SciencesKumamotoJapan
  5. 5.Department of PathologyKinki University School of MedicineOsakaJapan

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