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Utility of contrast-enhanced ultrasound with perflubutane for diagnosing the macroscopic type of small nodular hepatocellular carcinomas

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

To clarify the diagnostic value of contrast-enhanced ultrasound (CEUS) with perflubutane in the macroscopic classification of small nodular hepatocellular carcinomas (HCCs).

Methods

A total of 99 surgically resected nodular HCCs with a maximum diameter of 3 cm or less were analysed. HCCs were macroscopically categorized as simple nodular (SN) and non-SN. CEUS findings were evaluated during the arterial phase (vascularity, level and shape of enhancement), portal phase (presence or absence of washout) and post-vascular phase (echo intensity and shape).

Results

Sixty-eight HCCs were categorized as SN and the remaining 31 were categorized as non-SN. For diagnosis of non-SN HCC, the areas under the receiver operating characteristic curve (A z) value for the shape of enhancement in the late arterial phase and the shape of the post-vascular image were 0.824 (95 % confidence interval [CI] 0.721–0.895) and 0.878 (95 % CI 0.788–0.933), respectively. The A z value for the combination of the shape of enhancement in the late arterial phase and the shape of the post-vascular image for the diagnosis of non-SN HCC was 0.907 (95 % CI 0.815–0.956), corresponding to a high diagnostic value.

Conclusion

CEUS can provide high-quality imaging assessment for determining the macroscopic classification of small nodular HCCs.

Key points

• Non-SN is one of the poor prognostic factors in patients with HCC

• Assessment of macroscopic type provides valuable information for the management of HCC

• CEUS can provide high-quality imaging assessment for macroscopic classification of HCC

• For non-SN HCC diagnosed using CEUS, hepatectomy is preferred as curative treatment

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Abbreviations

CEUS:

contrast-enhanced ultrasound

CMN:

confluent multinodular

DVD:

digital versatile disc

HCC:

hepatocellular carcinoma

NPV:

negative predictive value

PPV:

positive predictive value

ROC:

receiver operating characteristic

SN:

simple nodular

SN-EG:

simple nodular with extranodular growth

US:

ultrasound

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Acknowledgments

The scientific guarantor of this publication is Toshifumi Tada. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Our institution did not require institutional approval or informed consent for review of patient records and images in this retrospective study. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Ogaki Municipal Hospital, Ogaki, Japan

    Toshifumi Tada, Takashi Kumada, Hidenori Toyoda, Takanori Ito, Yasuhiro Sone, Yuji Kaneoka, Atsuyuki Maeda, Seiji Okuda, Katsuhiko Otobe & Kenichi Takahashi

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  1. Toshifumi Tada
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  2. Takashi Kumada
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Correspondence to Toshifumi Tada.

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Tada, T., Kumada, T., Toyoda, H. et al. Utility of contrast-enhanced ultrasound with perflubutane for diagnosing the macroscopic type of small nodular hepatocellular carcinomas. Eur Radiol 24, 2157–2166 (2014). https://doi.org/10.1007/s00330-014-3254-2

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  • DOI: https://doi.org/10.1007/s00330-014-3254-2

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