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英文誌(2004-)

Journal of Medical Ultrasonics

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1999 - Vol.26

Vol.26 No.08

Original Article(原著)

(0939 - 0947)

肝細胞癌の血流評価におけるハワードプラ法の有用性に関する検討

Usefulness of Power Doppler Ultrasound for Evaluating Vascularity of Hepatocellular Carcinoma

久保 裕史1, 堀口 祐爾1, 今井 英夫1, 坂本 宏司1, 鈴木 智博1, 上松 正尚1, 竹内 文康1, 中村 祐子1, 豊田 秀徳1, 浅野 正裕1, 林 隆男1, 刑部 恵介1, 西川   徹1, 久志 有子2, 山田 久美2, 杉田 由紀子2

Hiroshi KUBO1, Yuji HORIGUCHI1, Hideo IMAI1, Hiroshi SAKAMOTO1, Tomohiro SUZUKI1, Masanao UEMATSU1, Fumiyasu TAKEUCHI1, Yuko NAKAMURA1, Hidenori TOYOTA1, Masahiro ASANO1, Takao HAYASHI1, Keisuke OSAKABE1, Tooru NISIKAWA1, Yuko KUSHI2, Kumi YAMADA2, Yukiko SUGITA2

1藤田保健衛生大学消化器内科, 2藤田保健衛生大学検査部

1Department of Gastroenterology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan, 2Laboratory Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan

キーワード : Color Doppler energy mode , Color Doppler imaging , Hepatocellular carcinoma , Power Doppler mode

The development of ultrasound equipment employing color Doppler energy (CDE) has allowed recent progress in the detectability of blood flow in hepatocellular carcinoma (HCC). We evaluated the detectability and reliability of CDE in the imaging diagnosis of vascularity in HCC by comparing its images with those obtained with ultrasonography using color Dopplerfl velocity (CDV), computed tomography using helical scanning (helical CT), ultrasound angiography using CO2 microbubbles (USAG), and other imaging modalities in 120 nodular-type HCCs. To measure detectability, we compared rate of detection of blood flow signals in CDE and CDV. To evaluate reliability, we analyzed the overlap ratio of detection of vascularity in HCC by imaging diagnosis based on CDE, helical CT, and USAG. We used the Acuson 128 XP/10 ART System (Acuson Corporation: Mountain View, CA) with 4.0 MHz vecta probes and 5.0 MHz convex probes for the CDE evaluation. When CDE and CDV were compared, CDE detected blood flow signals in 95 (79%) HCCs; CDV, in 83 (69%) HCCs. CDE detected blood flow signals in only 30 (57%) of 53 HCCs that were less than 2 cm in diameter, while CDV detected blood flow signals in only 20 (38%). To compare CDE, helical CT, and USAG, we divided HCCs into two groups according to detection of blood flow signals by CDE: HCCs in which CDE detected blood flow signals (group A, n=93) and HCCs in which CDE did not detect blood flow signals (group B, n= 18). Evaluation with helical CT showed hypervascularity in 90 (96.8%) of the HCCs in group A and in 10 (55.5%) of the HCCs in group B; the overlap ratio was 88%. The overlap ratio between CDE and USAG was 90% when evaluated by USAG. The result of comparison between CDE and CDV suggested the superiority of CDE over CDV in the detectability of blood flow signals of HCC. Comparison of CDE, helical CT, and USAG suggested that CDE imaging can reliability diagnose HCC. Blood flow signals were hard to evaluate in some HCCs in deep locations, because of attenuation of the sonic beam and, in the case of HCCs located in the left lobe of the liver, because of the motion of artifacts. These two areas that warrant further study.