Hepatocellular Carcinoma: Contrast-Enhanced Sonography
In patients with chronic liver disease, sono-graphy and measurements of serum alpha-fetoprotein (αFP) levels are frequently used to screen for hepatocellular carcinoma (HCC). The sensitivity of sonography for HCC detection, however, in the end-stage cirrhotic liver is only 50% (Dodd et al., 1992). Furthermore, sonographic findings of HCC are variable and frequently nonspecific. Hepatocellular carcinoma is highly vascularized and often shows irregular neovascularization within the tumor. Therefore, detection and characterization of tumor vascularity are important in the differential diagnosis, the choice of treatment method, and assessment of the therapeutic response for HCC. Although color and power Doppler sonography are helpful in detecting vascularity of hepatic tumors, it has not proved satisfactory.
Since intravenous microbubble contrast agents including SH U 508A (Levovist; Schering AG, Berlin, Germany) for sonography have become available, many researchers have reported that contrast-enhanced sonography could be a promising technique for assessing post-treatment response of HCC (Bartolozzi et al., 1998; Choi, D. et al., 2000; Ding et al., 2001; Meloni et al., 2001; Solbiati et al., 1999; Youk et al., 2003b) as well as for making a correct diagnosis of HCC by observing tumoral vascularity (Choi et al., 2000a; Dill-Macky et al., 2002; Kim et al., 1998; Wen et al., 2004). Indeed, there is an increasing consensus that the use of contrast agents improves the ability of sonography to detect and characterize focal hepatic lesions. Levovist, one of the most popular sonographic contrast agents, is a suspension of galactose microparticles in sterile water. The microbubbles (2–8 μm in diameter, with a mean of 3 μm), which are stabilized in the microparticle suspension, can traverse the pulmonary capillary bed and diverse into whole blood circulation (Kim et al., 1998).
KeywordsContrast Agent Percutaneous Ethanol Injection Mechanical Index Ultrasound Contrast Agent Power Doppler Sonography
Unable to display preview. Download preview PDF.
- Choi, B.I., Kim, T.K., Han, J.K., Kim, A.Y., Seong, C.K., and Park, S.J. 2000a. Vascularity of hepa-tocellular carcinoma: assessment with contrast-enhanced second-harmonic versus conventional power Doppler US. Radiology 214:381–386.Google Scholar
- Choi, D., Lim, H.K., Kim, S.H., Lee, W.J., Jang, H.J., Lee, J.Y., Paik, S.W., Koh, K.C., and Lee, J.H. 2000b. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: usefulness of power Doppler US with a microbubble contrast agent in evaluating therapeutic response-preliminary results. Radiology 217:558–563.Google Scholar
- Choi, D., Lim, H.K., Lee, W.J., Kim, S.H., Kim, Y.H., Kim, S.H., and Lim, J.H. 2003. Early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma: utility of gray scale harmonic ultrasonography with a microbubble contrast agent. J. Ultrasound Med. 22:1163–1172.PubMedGoogle Scholar
- Ding, H., Kudo, M., Onda, H., Suetomi, Y., Minami, Y., Chung, H., Kawasaki, T., and Maekawa, K. 2001. Evaluation of posttreatment response of hepatocellular carcinoma with contrast-enhanced coded phase-inversion harmonic US: comparison with dynamic CT. Radiology 221:721–730.PubMedCrossRefGoogle Scholar
- Kim, C.K., Choi, D., Lim, H.K., Kim, S.H., Lee, W.J., Kim, M.J., Lee, J.Y., Jeon, Y.H., Lee, J., Lee, S.J., and Lim, J.H. 2005a. Therapeutic response assessment of percutaneous radiofre-quency ablation for hepatocellular carcinoma: utility of contrast-enhanced agent detection imaging. Eur. J. Radiol. 56:66–73.CrossRefGoogle Scholar
- Kim, K.W., Choi, B.I., Park, S.H., Kim, H.C., Lee, M.W., Kim, S.H., Lee, K.H., Park, C.H., Kim, J.S., Won, H.J., and Han, J.K. 2003. Hepatocellular carcinoma: assessment of vascu-larity with single-level dynamic ultrasonography during the arterial phase. J. Ultrasound Med. 22:887–896.PubMedGoogle Scholar
- Kim, S.H., Lee, J.M., Lee, J.Y., Han, J.K., An, S.K., Han, C.J., Lee, K.H., Hwang, S.S., and Choi, B.I. 2005b. Value of contrast-enhanced sonography for the characterization of focal hepatic lesions in patients with diffuse liver disease: receiver operating characteristic analysis. AJR Am. J. Roentgenol. 184:1077–1084.Google Scholar
- Meloni, M.F., Goldberg, S.N., Livraghi, T., Calliada, F., Ricci, P., Rossi, M., Pallavicini, D., and Campani, R. 2001. Hepatocellular carcinoma treated with radiofrequency ablation: comparison of pulse inversion contrast-enhanced harmonic sonography, contrast-enhanced power Doppler sonography, and helical CT. AJR Am. J. Roentgenol. 177:375–380.PubMedGoogle Scholar
- von Herbay, A., Vogt, C., Willers, R., and Haussinger, D. 2004. Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions. J. Ultrasound Med. 23:1557–1568.Google Scholar
- Youk, J.H., Kim, C.S., and Lee, J.M. 2003a. Contrast-enhanced agent detection imaging: value in the characterization of focal hepatic lesions. J. Ultrasound Med. 22:897–910.Google Scholar
- Youk, J.H., Lee, J.M., and Kim, C.S. 2003b. Therapeutic response evaluation of malignant hepatic masses treated by interventional procedures with contrast-enhanced agent detection imaging. J. Ultrasound Med. 22:911–920.Google Scholar