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Journal of Gastroenterology

, Volume 49, Issue 4, pp 755–763 | Cite as

New malignant grading system for hepatocellular carcinoma using the Sonazoid contrast agent for ultrasonography

  • Hironori Tanaka
  • Hiroko Iijima
  • Akiko Higashiura
  • Kazunori Yoh
  • Akio Ishii
  • Tomoyuki Takashima
  • Yoshiyuki Sakai
  • Nobuhiro Aizawa
  • Kazunari Iwata
  • Naoto Ikeda
  • Yoshinori Iwata
  • Hirayuki Enomoto
  • Masaki Saito
  • Hiroyasu Imanishi
  • Seiichi Hirota
  • Jiro Fujimoto
  • Shuhei Nishiguchi
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

The ultrasonography contrast agent Sonazoid provides parenchyma-specific contrast imaging (Kupffer imaging) based on its accumulation in Kupffer cells. This agent also facilitates imaging of the fine vascular architecture in tumors through maximum intensity projection (MIP). We examined the clinical utility of the malignancy grading system for hepatocellular carcinoma (HCC) using a combination of 2 different contrast-enhanced ultrasonography images.

Methods

We studied 121 histologically confirmed cases of HCC (well-differentiated, 45; moderately differentiated, 70; poorly differentiated, 6). The results of Kupffer imaging were classified as (1) iso-echoic pattern or (2) hypo-echoic pattern. The MIP patterns produced were classified into one of the following categories: fine, tumor vessels were not clearly visualized and only fine vessels were visualized; vascular, tumor vessels were visualized clearly; irregular, tumor vessels were thick and irregular. Based on the combined assessment of Kupffer imaging and the MIP pattern, the samples were classified into 4 grades: Grade 1 (iso-fine/vascular), Grade 2 (hypo-fine), Grade 3 (hypo-vascular), and Grade 4 (hypo-irregular).

Results

The distribution of moderately and poorly differentiated HCCs was as follows: Grade 1, 4 % (1/24); Grade 2, 52 % (15/29); Grade 3, 85 % (44/52); and Grade 4, 100 % (16/16). The grading system also predicted portal vein invasion in 72 resected HCCs: Grade 1, 0 % (0/4); Grade 2, 13 % (1/8); Grade 3, 23 % (11/48); and Grade 4, 67 % (8/12).

Conclusions

This new malignant grading system is useful for estimation of histological differentiation and portal vein invasion of HCC.

Keywords

Hepatocellular carcinoma Contrast enhanced ultrasonography Sonazoid Malignant grade 

Notes

Conflict of interest

Shuhei Nishiguchi received financial support from Chugai Pharmaceutical, MSD, Dainippon Sumitomo Pharma, Ajinomoto Pharma, and Otsuka Pharmaceutical. Hiroko Iijima received financial support from Chugai Pharmaceutical. Hiroyasu Imanishi received financial support from Chugai Pharmaceutical. The remaining authors have no conflict of interest.

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Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Hironori Tanaka
    • 1
    • 2
  • Hiroko Iijima
    • 1
    • 2
  • Akiko Higashiura
    • 1
  • Kazunori Yoh
    • 2
  • Akio Ishii
    • 1
  • Tomoyuki Takashima
    • 2
  • Yoshiyuki Sakai
    • 2
  • Nobuhiro Aizawa
    • 2
  • Kazunari Iwata
    • 2
  • Naoto Ikeda
    • 2
  • Yoshinori Iwata
    • 2
  • Hirayuki Enomoto
    • 2
  • Masaki Saito
    • 2
  • Hiroyasu Imanishi
    • 2
  • Seiichi Hirota
    • 3
  • Jiro Fujimoto
    • 4
  • Shuhei Nishiguchi
    • 2
  1. 1.Ultrasound Imaging CenterHyogo College of MedicineNishinomiyaJapan
  2. 2.Division of Hepatobiliary and Pancreas Disease, Department of Internal of MedicineHyogo College of MedicineNishinomiyaJapan
  3. 3.Department of Surgical PathologyHyogo College of MedicineNishinomiyaJapan
  4. 4.Division of Hepatobiliary and Pancreatic Disease, Department of External MedicineHyogo College of MedicineNishinomiyaJapan

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