Sonographic Characterisation of Hepatocellular Carcinoma at Time of Diagnosis

Zusammenfassung

Hintergrund: Das hepatozelluläre Karzinom (HCC) ist ein maligner Lebertumor mit weltweit hoher Prävalenz. Als Screeningmethode werden in der Regel die konventionelle B-Bild-Sonographie und die laborchemische AFP-Bestimmung verwendet. Ziel der Untersuchung war es, sonographische Kriterien an 100 nicht selektierten Patienten mit HCC zum Zeitpunkt der Diagnosestellung zu überprüfen und die Anwendung von Echosignalverstärkern bei HCC zu evaluieren. Patienten und Methoden: 100 konsekutive Patienten mit histologisch gesicherten hepatozellulären Karzinomen wurden hinsichtlich der Echogenität, des Vaskularisationsmusters und Tumorthrombosen untersucht. Die kontrastverstärkte Power-Doppler-Sonographie mit SHU 508A wurde bei 65 Patienten eingesetzt. Ergebnis: Die Echogenität der hepatozellulären Karzinome war hypoechogen bei 48 %, isoechogen bei 9 %, hyperechogen bei 19 % und bei 25 % gemischt echogen im Vergleich zum umgebenden Lebergewebe. Die signalverstärkte Power-Doppler-Sonographie mit SHU 508A verbesserte die richtige Einschätzung der Tumorvaskularisation als hypervaskulär im Vergleich zum nativen Power-Doppler bei 27 % der Patienten, hauptsächlich bei kleinen Läsionen. Diskussion: Zum Zeitpunkt der Diagnosestellung erscheinen die meisten hepatozellulären Karzinome unabhängig von ihrer Größe hypervaskulär. Der Einsatz von Echosignalverstärkern führt zu einer verbesserten Einschätzung bezüglich der Vaskularisation. Die Häufigkeit arteriell hypovaskularisierter hepatozellulärer Karzinome nach der Anwendung von Ultraschallkontrastmitteln liegt bei etwa 10 %.

Abstract

Background: Hepatocellular carcinoma (HCC) is a malignant liver tumour with a high prevalence world-wide. For screening procedures conventional transabdominal B-mode ultrasound and AFP determination are commonly used. We investigated 100 consecutive patients with histologically proven hepatocellular carcinoma in order to evaluate sonographic characteristics in unselected patients and to compare native and contrast-enhanced ultrasonographic techniques. Patients and Methods: We investigated 100 consecutive patients with hepatocellular carcinoma at time of diagnosis with respect to echogenicity, patterns of vascularity, and portal/hepatic vein thrombosis. In addition to B-mode and native power Doppler sonography, contrast-enhanced power Doppler sonography with SHU 508A was used in 65 patients. Results: The ultrasound appearance with conventional B-mode of hepatocellular carcinoma was hypoechoic in 48 % of the cases, isoechoic in 9 %, hyperechoic in 19 %, and in 25 % a mixture between hyper- and hypoechoic appearance was found compared to the surrounding liver tissue. Contrast-enhanced power Doppler sonography with SHU 508A changed the pattern of tumour vascularity in 27 % of patients into hypervascular, mainly in small lesions. Discussion: At the time of diagnosis, the most commonly observed finding in hepatocellular carcinoma is that they appear hypervascular, independent of their size. The use of ultrasound contrast media should be considered to achieve characterisation of liver nodules in cirrhotic livers because they can improve the evaluation of tumour vascularity. Hypovascular HCC are found in about 10 % even after the administration of a contrast agent.

Sonographie - Echotextur - B-Mode - Vaskularisation - kontrastverstärkte Power-Doppler-Sonographie - Leberzirrhose

Ultrasonography - echotexture - B-mode - vascularity - colour Doppler imaging - liver cirrhosis

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