原 浩二¹, 沼田 和司^{1, 2}, 田中 克明^{1, 3}, 斉藤 聡¹, 森本 学³, 池田 正徳¹, 岩瀬 滋¹, 松本 秀平¹, 米沢 広美², 窪田 徹⁴, 関原 久彦¹

Koji HARA¹, Kazushi NUMATA^{1, 2}, Katsuaki TANAKA ^{1, 3}, Satoru SAITO¹, Manabu MORIMOTO³, Masanori IKEDA¹, Shigeru IWASE¹, Shuhei MATSUMOTO¹, Hiromi YONEZAWA², Toru KUBOTA⁴, Hisahiko SEKIHARA¹

¹横浜市立大学医学部第三内科, ²横浜市立大学臨床検査部, ³横浜市立大学医学部付属市民総合医療センター消化器病センター内料, ⁴横浜市立大学第二外科　

¹Third Department of Internal Medicine, Yokohama City University of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa-ken 236-0004, Japan, ²Clinical Laboratory, Yokohama City University of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa-ken 236-0004, Japan, ³Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama-shi, Kanagawa-ken 232-0024, Japan, ⁴Second Department of Surgery, Yokohama City University of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa-ken 236-0004, Japan

キーワード : Contrast-enhanced harmonic gray-scale imaging, Helical CT, Hepatocellular carcinoma, Levovist, US angiography

We compared contrast-enhanced harmonic gray-scale imaging with helical CT and US angiography to evaluate vascularity in advanced hepatocellular carcinoma (HCC). Contrast-enhanced harmonic gray-scale imaging using Levovist (Nihon Schering, Tanabe) as the contrast agent and enhanced helical CT were performed on 38 patients with 45 lesions (29 men and 9 women aged 41 to 83 years; mean age, 66 years; mean maximum tumor diameter, 30. 5±23.0 mm), and angiography was performed to evaluate 37 lesions from 32 of these 38 patients (24 men and 8 women, aged 41 to 79 years; mean age, 65 years; mean maximum tumor diameter, 27. 9±17. 9 mm). Contrast-enhanced harmonic gray-scale imaging showed hypervascular enhancement in 41 of the 45 lesions; the other 4 lesions were not visualized as hypervascular because 3 of the them could not be detected with non-enhanced US and the remaining lesion was situated deep in the liver and more than 11 cm from the surface of the body. Helical CT showed areas of high attenuation in 40 of the 45 lesions, leaving the other 5 lesions equivocal, while US angiography achieved positive enhancement in 36 of 37 lesions. Intratumoral vessels were visualized with contrast-enhanced harmonic gray-scale imaging in 25 of the 45 lesions; however; intratumoral vessels were seen in only 4 of the 45 lesions examined with helical CT. In evaluating vascularity in advanced HCC, contrast-enhanced harmonic gray-scale imaging with Levovist was as effective as US angiography and more effective than helical CT. Motion artifacts produced by the heart make it difficult to evaluate vascularity in advanced HCC located in the left lobe of the liver with Doppler sonography. Contrast-enhanced harmonic gray-scale imaging can show intratumoral vessels and hypervascular enhancement of the tumor without motion artifacts, however, even when the tumor is located near the heart or large vessels. Contrast-enhanced harmonic gray-scale imaging is useful for evaluating vascularity in advanced HCC when the tumor can be visualized with non-enhanced US.