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Hepatocellular Carcinoma

Assessment of Vascularity With Single-Level Dynamic Ultrasonography During the Arterial Phase

Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea (B.I.C., S.H.P., H.-C.K., M.W.L., S.H.K., K.H.L., C.H.P., J.S.K., J.K.H.); and Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (K.W.K., H.-J.W.).

Address correspondence and reprint requests to Byung Ihn Choi, MD, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. E-mail: choibi{at}radcom.snu.ac.kr.

Objective. To evaluate the hemodynamic features of hepatocellular carcinoma on single-level dynamic ultrasonography during the arterial phase. Methods. Twenty-two hepatocellular carcinomas were examined by single-level dynamic ultrasonography with high transmit intensity and SH U 508A. The scans were performed for 40 seconds with a 1-second interval between each ultrasound transmission and with individual optimization of the scan delay time. The times of initiation of enhancement for both the hepatic artery and the tumor and the time of maximal enhancement for the tumor were recorded, and the mean echo values at every second for the tumor and hepatic parenchyma were measured. Results. Twelve tumors showed hyperechoic enhancement compared with hepatic parenchyma throughout the scans. The other 10 showed hyperechoic enhancement during some segments (range, 8–34 seconds) and either isoechoic (n = 5) or hypoechoic (n = 5) enhancement during the remaining parts; the hyperechoic segments were often short (<20 seconds, 14%). Although the times for initiation of enhancement for the hepatic artery and hepatocellular carcinoma and the time of maximal enhancement for the tumor varied, the tumor usually initiated enhancement immediately after the hepatic artery (r = 0.986; P = .000001). The interval between the time of initiation of enhancement for the tumor or hepatic artery and that of maximal enhancement for the tumor was significantly correlated with the tumor size (r = 0.700; P = .008; and r = 0.780; P = .002). Conclusions. With individual optimization of the scan delay time, single-level dynamic ultrasonography is useful for depicting the hypervascularity of hepatocellular carcinoma during the arterial phase.

Key Words: contrast media • liver neoplasms • liver neoplasms • ultrasonography • ultrasonography

Abbreviations: CEUS, contrast-enhanced ultrasonography • CT, computed tomographic • HCC, hepatocellular carcinoma • PC, personal computer • SLDUS, single-level dynamic ultrasonography • TiHA, time of initiation of enhancement for the hepatic artery • TiHCC, time of initiation of enhancement for hepatocellular carcinoma • TMHCC, time of maximal enhancement for HCC

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