斎藤 明子^{1, 2}, 片桐 聡², 山本 雅一², 幕内 雅敏¹

Akiko SAITO^{1, 2}, Satoshi KATAGIRI², Masakazu YAMAMOTO², Masatoshi MAKUUCHI¹

¹日本赤十字社医療センター消化器内科, ²東京女子医科大学消化器病センター

¹Gastroenterology and Hepatology, Japanese Red Cross Medical Center, ²Institute of Gastroenterology, Tokyo Women’s Medical University

キーワード :

We examined the reliability of CEUS for HCC diagnosis.
【METHODS】
Starting in 2007，we identified pathologically confirmed 143 nodules（118 HCC and 25 benign nodules including adenoma, focal nodular hyperplasia, alcoholic and unclassified hyperplastic nodules）in 143 patients. Nodule hemodynamics were observed with special attention to the pure arterial and early portal phases up to 1 min after Sonazoid（0.01ml/kg）injection followed by subsequent phase up to 30 minutes. Enhancements of nodules as compared to the non-tumor parenchyma were divided into 3 types; hyper, iso and hypo. We calculated covariance-adjusted sensitivities for nodule enhancement combinations of the three phases. We used Prosoundα10，F75 and Ascendus（Hitachi-ALOKA c/o, Japan）with inflow-time mapping, arterial capture or a time-intensity curve to observe the nodule vascularity.
【RESULTS】
1）Poorly differentiated（PD）HCC showed three enhancement patterns, hypo-hyper-hypo, hypo-iso-hypo and hyper-hyper-hypo, with respective likelihoods of a nodule being PD of 65％，13％and 8％．2）All moderately differentiated（MD）HCC were hyper in the pure arterial and hypo in the subsequent phase. If a nodule showed the hypo, iso or hyper in the early portal phase, the respective likelihoods of being MD were 96％，83％and 79％．3）Well-differentiated（WD）HCC showed several complex patterns but 68％were hypo in the arterial phase. If three phases were all hypo or hypo-iso-iso, nodules were WD. The iso-iso-hypo and iso-iso-iso patterns indicated a nearly 95％likelihood of a nodule being WD. The hypo-iso-hypo pattern carried a 13％risk of PD, though the remaining 87％were WD. 4）Most benign nodules were hyper in both pure arterial and early portal phases. Nodules with all three phases being hyper were consistently benign. Of those with an iso subsequent phase, 95％were benign. The hypo subsequent phase was rare but 12％were benign nodules.
【CONCLUSION】
By dividing the very early phase into pure arterial and early portal phases, CEUS can provide information useful for determining the likely degree of HCC differentiation and for distinguishing HCC from benign nodules.