Comparison of MicroFlow Imaging with color and power Doppler imaging for detecting and characterizing blood flow signals in hepatocellular carcinoma
Jae Seok Bae1 , Jeong Min Lee1, Sun Kyung Jeon1, Siwon Jang2
1Department of Radiology, Seoul National University Hospital, Seoul, Korea
2Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
Corresponding Author: Jeong Min Lee ,Tel: 0220723154, Fax: 027436385, Email:
Received: June 10, 2019;  Accepted: July 9, 2019.  Published online: July 9, 2019.
To compare the sensitivity of MicroFlow Imaging (MFI) with those of color and power Doppler imaging (CDI and PDI, respectively) in detecting the vascularity of hepatocellular carcinomas (HCCs).
This prospective study enrolled 51 patients diagnosed with HCCs between August 2018 and December 2018. CDI, PDI, MFI, and contrast-enhanced ultrasound (CEUS) were performed. Two radiologists evaluated the presence and pattern of tumoral vascularity on CDI, PDI, and MFI. Vascular presence was graded on a five-point scale (0, absent; 4, >50% of the tumor). Vascular pattern was chosen from following categories: basket, vessels-in-tumor, spot, detouring, mixed, or others. Two additional radiologists assessed CEUS images for the presence and pattern of tumoral vascularity, which served as the reference standard. If tumoral vascular pattern on each examination matched that of CEUS images, the Wilcoxon test and McNemar test, respectively, were used to compare the sensitivity for detecting tumoral vascularity between MFI and CDI, and between MFI and PDI. Logistic regression analysis was performed to identify factors associated with MFI detectability of tumoral vascularity.
CEUS demonstrated tumoral vascularity in 98% (50/51) of patients. MFI (58.0% [29/50]) demonstrated a higher sensitivity than CDI (14.0% [7/50]) or PDI (14.0% [7/50]) (P<0.001 for both) in detecting tumoral vascularity, provided that vascular pattern was correctly depicted. Only tumor depth was associated with the MFI detectability of tumoral vascularity.
The sensitivity of MFI was higher than that of CDI or PDI in detecting vascularity of HCCs, when the vascular pattern was considered. MFI better detected the vascularity of shallow tumors.
Keywords: Ultrasonography; Ultrasonography, Doppler, Color; Carcinoma, Hepatocellular
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