Journal of Korean Society of Medical Ultrasound 2001;20(3): 167-174.
Differentiation of Dysplastic Nodule from Hepatocellular Carcinoma on Contrast-Enhanced Power and Pulsed Doppler US.
Jung Hee Shin, Seung Yon Baek, Byung Chul Kang, Hye Kyung Chung
1Department of Radiology, Ewha Womans University, Korea.
2Department of Internal Medicine, Ewha Womans University, Korea.
  Published online: September 1, 2001.
PURPOSE: The purpose of this study was to differentiate dysplastic nodule (DN) from hepatocellular carcinoma (HCC) in patients with liver cirrhosis on contrast-enhanced power and pulsed Doppler US. MATERIALS AND METHODS: Twenty-one patients with liver cirrhosis and a focal lesion were included. They consisted of biopsyproven 12 DNs(mean diameter: 1.8 cm, M:F = 5:7, mean age 60) and 9 HCCs(mean diameter: 2.3cm, M:F = 6:3, mean age 63). All the patients were prospectively examined with Acuson Computed Sonography 128XP/10 and 4MHz vector transducer. Gray-scale US was done to assess the echogenicity of the focal lesion. Vascular flow signals within the focal lesion were examined with power Doppler US. After the injection of 7ml(300mg/ml) suspension of US contrast agent (Levovist, Schering, Berlin, Germary), vascular flow signals were graded to 4 grades on power Doppler US. Arterial and/or venous flow pattern on pulsed Doppler US were evaluated. Statistical analysis was done using chi-square method. RESULTS: On gray-scale US, 10 (83%) DNs showed hypoechogenicity and the other two (17%) showed hypere-chogenicity. 7 (78%) HCCs were hypoechoic and two (22%) were hyperechoic. On non-enhanced power Doppler US, all 12 cases (100%) of DNs had no vascular flow signal and four cases of nine HCCs (grade II : three, grade III : one) revealed vascular flow signals (p=0.429). On contrast-enhanced power Doppler US, 11 cases (92%) of DNs and all cases (100%) of HCCs showed increased vascular flow signals. Three (24%) of DNs and 7(78%) of HCCs showed grade III and IV . There was a statistical difference in the grade of vascular flow signals between two groups (p=0.03). On pulsed Doppler US, the arterial flow was present in 2 (17%) DNs and 8 (89%) HCCs (p=0.002) and venous flow was present in 11 (92%) DNs and 5 (56%) HCCs. Combined flow appeared in 2 cases (16%) of DNs and 4 cases (44%) of HCCs. CONCLUSION: In differentiating DN from HCC, the higher probability of HCC can be considered if a focal lesion in cirrhotic patient has grade III or IV of vascular flow signals on contrast-enhanced power Doppler US and arterial flow on pulsed Doppler US.
Keywords: Liver neoplasms; Ultrasound(US), contrast media; Ultrasound(US), power Doppler studies
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