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Evaluation of the Vascular Architecture of Hepatocellular Carcinoma by Micro Flow Imaging

Pathologic Correlation

Departments of Medical Ultrasonics (H.Y., G.-J.L., H.-X.X., X.-Y.X.) and Hepatobiliary Surgery (M.-D.L.), The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Address correspondence to Ming-De Lu, MD, DMSc, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Rd 2, 510080 Guangzhou, China. E-mail: lumd{at}21cn.com

Objective. The purpose of this study was to evaluate micro flow imaging (MFI) in depicting the vascular architecture of hepatocellular carcinoma (HCC) and the correlation between pathologic differentiation and the intratumoral vascular architecture pattern. Methods. Micro flow imaging and contrast harmonic imaging (CHI) were performed in 37 patients with HCC. A sulfur hexafluoride-filled microbubble contrast agent was used. The enhancement level and intratumoral vessels were evaluated on CHI. The vascular architecture of each tumor was evaluated on MFI. Pathologic differentiation of the tumors was classified according to the Edmondson grading system. Results. All 37 HCCs showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases on CHI. Intratumoral vessels in the arterial phase were visualized in 20 (54.1%) HCCs. On MFI, the vascular architecture in all lesions was clearly delineated and categorized into 3 patterns: cotton, shrubbery, and deadwood, identified in 12 (32.4%), 22 (59.5%), and 3 (8.1%) of the tumors evaluated, respectively. A ² test showed that pathologic differentiation significantly correlated to the vascular pattern (P = .006). Three (75%) of 4 Edmondson grade I HCCs showed the cotton pattern; 18 (75.0%) of 24 Edmondson grade II HCCs showed the shrubbery pattern; and the deadwood pattern was shown only in Edmondson grade III and IV HCCs. Conclusions. The MFI technique is more effective in depicting the intratumoral vascular architecture. The vascular architecture pattern correlates with pathologic differentiation of HCC.

Key Words: contrast-enhanced ultrasonography • contrast harmonic imaging • hepatocellular carcinoma • micro flow imaging • vascular architecture

Abbreviations: AP, acoustic power • CEUS, contrast-enhanced ultrasonography • CHI, contrast harmonic imaging • FLL, focal liver lesion • FRS, flash-replenishment sequence • HCC, hepatocellular carcinoma • MFI, micro flow imaging • MI, mechanical index

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