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A study on the inconsistency of arterial phase hypervascularity detection between contrast-enhanced ultrasound using sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid magnetic resonance imaging of hepatocellular carcinoma lesions

  • Original Article–Gastroenterology
  • Published:
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Abstract

Purpose

By analyzing possible factors contributing to imaging misevaluation of arterial phase (AP) vascularity, we aimed to provide a more proper way to detect AP hypervascularity of hepatocellular carcinomas (HCCs) using the noninvasive imaging modalities magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS).

Methods

We retrospectively recruited 164 pathologically confirmed HCC lesions from 128 patients. Using CEUS with Sonazoid (SCEUS) and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid MRI (EOB-MRI), AP vascularity of the lesions was evaluated and inconsistencies in interpretation were examined. Indicators of margin, echogenicity, and halo and mosaic signs of lesions on grayscale US; depth of lesions on SCEUS; and tumoral homogeneity, signal contrast ratio of lesions to the surrounding area on precontrast and AP images on EOB-MRI, and histological grade were investigated.

Results

When precontrast images were used to adjust the AP enhancement ratio, the proportion of inconsistent interpretations of AP vascularity declined from 26.2% (43/164; 29 non-hypervascularity instances using EOB-MRI and 14 using SCEUS) to 16.5% (27/164; 7 using EOB-MRI and 20 using SCEUS). Greater lesion depth (P = 0.017), ill-defined tumoral margin (P = 0.028), absence of halo sign (P = 0.034), and histologically early HCC (P = 0.007) on SCEUS, and small size (P = 0.012) and heterogeneity (P = 0.013) of lesions and slight enhancement (low AP enhancement ratio) (P = 0.018 and 0.009 before and after adjustment) on EOB-MRI, may relate to undetectable hypervascularity.

Conclusions

SCEUS and EOB-MRI may show discrepancies in evaluating AP vascularity in the case of deep, ill-defined, heterogeneous, slightly enhanced lesions, and histologically early HCCs. We recommend adjusting AP with precontrast images in EOB-MRI, and combining both modalities to detect hypervascularity.

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Authors and Affiliations

  1. Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan

    Feiqian Wang, Kazushi Numata, Makoto Chuma, Haruo Miwa, Satoshi Moriya & Katsuaki Ogushi

  2. Ultrasound Department, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, China

    Feiqian Wang

  3. Department of Radiology, Nihon University School of Medicine, Tokyo, 173-8610, Japan

    Masahiro Okada

  4. Division of Diagnostic Pathology, Yokohama City University Medical Center, Kanagawa, 232-0024, Japan

    Masako Otani & Yoshiaki Inayama

  5. Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, 236-0004, Japan

    Shin Maeda

Authors
  1. Feiqian Wang
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  2. Kazushi Numata
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  3. Makoto Chuma
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  4. Haruo Miwa
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  5. Satoshi Moriya
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  10. Shin Maeda
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Correspondence to Kazushi Numata.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The requirement for informed consent was waived in the study.

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Wang, F., Numata, K., Chuma, M. et al. A study on the inconsistency of arterial phase hypervascularity detection between contrast-enhanced ultrasound using sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid magnetic resonance imaging of hepatocellular carcinoma lesions. J Med Ultrasonics 48, 215–224 (2021). https://doi.org/10.1007/s10396-021-01086-2

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  • DOI: https://doi.org/10.1007/s10396-021-01086-2

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