Online Journal
電子ジャーナル
IF値: 1.878(2021年)→1.8(2022年)

英文誌(2004-)

Journal of Medical Ultrasonics

一度このページでloginされますと,Springerサイト
にて英文誌のFull textを閲覧することができます.

cover

2003 - Vol.30

Vol.30 No.02

Original Article(原著)

(J199 - J205)

ExPHD造影モードを用いた肝腫瘍造影能の検討

Evaluation of Contrast Harmonic Imaging of Hepatocellular Carcinoma by Levovist-Enhanced Ultrasound Using Extended Pure Harmonic Detection

川地 俊明1, 熊田 卓2, 小川 定信1, 日比 敏男1, 丹羽 文彦1, 後藤 繁優1, 加藤 廣正1, 高木 明美1, 安田 英明1, 市川 秀男1

Toshiaki KAWACHI1, Takashi KUMADA2, Sadanobu OGAWA1, Toshio HIBI1, Fumihiko NIWA1, Shigemasa GOTO1, Hiromasa KATOU1, Akemi TAKAGI1, Hideaki YASUDA1, Hideo ICHIKAWA1

1大垣市民病院診療検査科, 2大垣市民病院消化器科

1Department of Clinical Research, Ogaki Municipal Hospital, 2Department of Gastroenterology, Ogaki Municipal Hospital

キーワード : contrast harmonic imaging, extended pure harmonic detection, hepatocellular carcinoma, Levovist<sup>&#174;</sup>, line density

ExPHD (Extended Pure Hamonic Detection)を搭載したALOKA社製Pro Sound II SSD-6500を使用する機会を得たので, 同装置におけるLevovist® (SHU 508 A, Schering)静注Contrast Harmonic Imaging (CHI)の肝腫瘍染影能を検討した. 対象はCTHA (CT during hepatic arteriography)あるいはヘリカルCTの造影早期動脈相で多血性と診断され, 造影エコ−所見と比較できた肝細胞癌28症例29結節である. 内訳は男性20例, 女性8例, 平均年齢68歳, 平均腫瘍径は20.5±5.6 mmであった. 撮影パラメータとしてMI (mechanical index)値は最大1.5 (フォーカス点により, 自動的に設定される), フォーカスは腫瘍下縁付近の1点フォーカスとし, 送信周波数は1.88又は2.14 MHz, 受信周波数は3.76又は4.28 MHzとした. Line density (1 frameあたりの走査線密度)はlow, highを適宜設定し, ゲインは造影効果を明瞭化させるため, やや低めに設定した. 撮像方法は, Levovist® 7 ml (300 mg/ml)を急速注入 (1 ml/sec)し, 腫瘍近傍の動脈が描出される時相で息止めを行いvascular imageは5 frame/秒で, 10〜20秒間の観察を行い, その後に適時1〜2 frame/秒の間欠送信法にてperfusion imageを撮像した. 検討項目は, 造影能評価を行うために, 腫瘍存在深部 (体表からの深さからみた腫瘍の部位)とvascular image及びperfusion imageの評価, line density及び送信周波数の違いによるvascular imageにおける腫瘍血管の造影能と鮮鋭度 (空間分解能)について視覚的評価を行なった. 腫瘍存在深部とvascular imageにおいて, 腫瘍存在深部に関係なく29結節全例に腫瘍流入血管が描出された. perfusion imageにおいて肝実質より高輝度に造影されたのは29例中23例 (79.3%)で, 深部ほど造影能は低下した. 送信周波数の検討では, 腫瘍血管造影能では10例中6例 (60%)が2.14 MHzに比し1.88 MHzのCHIの方が優れた. 一方, 鮮鋭度 (空間分解能)は1.88 MHzに比し2.14 MHzのCHIの方が優れていた. Line densityの検討では腫瘍血管造影能では9例中6例 (66.7%) がline densityがhighに比べてlowによるCHIの方が優れていた. 一方, 鮮鋭度 (空間分解能)において9例中6例 (66.7%)はlowに比べて, highによるCHIの方が優れていた. ExPHD法を用いたLevovist®静注CHIにおいて肝腫瘍血管は全例描出された. うち腫瘍部のperfusion imageは79.3%で肝実質より輝度が高くなり, 腫瘍の血流動態の評価における本法を用いた造影超音波検査の有用性が示された.

We evaluated the efficacy of contrast harmonic imaging with Levovist (SHU 508 A, Schering) using a Pro Sound II SSD-6500 ultrasound system equipped with extended pure harmonic detection (Aloka Co Ltd). The objects were 29 nodules in 28 patients with hepatocellular carcinoma that were diagnosed as hypervascular by CT during hepatic arteriography or contrast-enhanced helical CT in the early phase and could also be compared with the contrast harmonic imaging. The patients were 20 men and 8 women averaging 68 years of age. Mean tumor diameter was 20賊5.6 mm. The maximum mechanical index was 1.5, automatically determined by the point of focus, which was set at a single point at the base of the tumor. Transmission frequency was 1.88 or 2.14 MHz, and reception frequency was 3.76 or 4.28 MHz. Line density was set appropriately at low or high, and gain was set lower to ensure that the enhancement effect would be clear. After a bolus injection of 7 ml (300 mg/ml) of Levovist, vascular imaging was first observed at 5 frames per second for approximately 10 to 20 seconds, after which the perfusion image was observed by intermittent transmission. We studied the relationships between the vascular or the perfusion image of the tumor and the depth of the tumors below the surface of the skin, line density, and transmission frequency. Afferent vessels were observed in all 29 nodules regardless of tumor depth. Tumors were more enhanced than the liver parenchyma in 23 of the 29 nodules (79%). The stain effect decreased with depth. The stain effect at 1.88 MHz was superior to that at 2.14 MHz in 6 of the 10 cases, although contrast harmonic imaging at 2.14 MHz was superior to that at 1.88 MHz in 4 of the 10 cases. The stain effect of the low line density was superior to that of the high line density in six of the nine cases (67%), while contrast harmonic images with the high line density were superior to those with low line density in six of the nine cases (67%). Contrast-enhanced ultrasonography with extended pure harmonic detection mode and administration of Levovist was useful in evaluating vascularity of hepatocellular carcinoma.