Liver Cancer
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 21, 2006; 12(39): 6290-6298
Published online Oct 21, 2006. doi: 10.3748/wjg.v12.i39.6290
Prospective study of differential diagnosis of hepatic tumors by pattern-based classification of contrast-enhanced sonography
Kazushi Numata, Tetsuo Isozaki, Manabu Morimoto, Kazuya Sugimori, Reiko Kunisaki, Toshio Morizane, Katsuaki Tanaka
Kazushi Numata, Tetsuo Isozaki, Manabu Morimoto, Kazuya Sugimori, Reiko Kunisaki, Katsuaki Tanaka, Gastroenterological Center, Yokohama City University Medical Center, Yokohama 232-0024, Japan
Toshio Morizane, Department of Medicine, Kanagawa Dental College, Yokosuka 238-0003, Japan
Correspondence to: Kazushi Numata, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. kz-numa@urahp.yokohama-cu.ac.jp
Telephone: +81-45-2615656 Fax: +81-45-2619492
Received: July 15, 2006
Revised: July 18, 2006
Accepted: July 22, 2006
Published online: October 21, 2006
Abstract

AIM: To prospectively evaluate the usefulness of a pattern-based classification of contrast-enhanced sonographic findings for differential diagnosis of hepatic tumors.

METHODS: We evaluated the enhancement pattern of the contrast-enhanced sonography images in 586 patients with 586 hepatic lesions, consisting of 383 hepatocellular carcinomas, 89 metastases, and 114 hemangiomas. After injecting a galactose-palmitic acid contrast agent, lesions were scanned by contrast-enhanced harmonic gray-scale sonography in three phases: arterial, portal, and late. The enhancement patterns of the initial 303 lesions were classified retrospectively, and multiple logistic regression analysis was used to identify enhancement patterns that allowed differentiation between hepatic tumors. We then used the pattern-based classification of enhancement we had retrospectively devised to prospectively diagnose 283 liver tumors.

RESULTS: Seven enhancement patterns were found to be significant predictors of different hepatic tumors. The presence of homogeneous or heterogeneous enhancement both in the arterial and portal phase was the typical enhancement pattern for hepatocellular carcinoma, while the presence of peritumoral vessels in the arterial phase and ring enhancement or a perfusion defect in the portal phase was the typical enhancement pattern for metastases, and the presence of peripheral nodular enhancement both in the arterial and portal phase was the typical enhancement pattern for hemangioma. The sensitivity, specificity, and accuracy of prospective diagnosis based on the combinations of enhancement patterns, respectively, were 93.2%, 96.2%, and 94.0% for hepatocellular carcinoma, 87.9%, 99.6%, and 98.2% for metastasis, and 95.6%, 94.1%, and 94.3% for hemangioma.

CONCLUSION: The pattern-based classification of the contrast-enhanced sonographic findings is useful for differentiating among hepatic tumors.

Keywords: Contrast-enhanced sonography; Hepato-cellular carcinoma; Metastasis; Hemangioma