| Objective: To study hepatic tumors with color Doppler flow image (CDFI) ,pulse wave Doppler (PW) ,color power angiography (CPA) and three-dimensional color power angiography(3D-CPA), the blood supply and hemodynamic parameters of hepatic tumors were recorded, tumor vessels quantitated with CPA and 3D-CPA were compared to their pathology and microvessel density(MVD) derived from immunohistochemistry. The aims were to analyze the characteristics of blood supply and hemodynamics in different hepatic tumors, explore the vessels pathologic basis of Doppler sonography in detecting and quantitating tumor vessels, evaluate their clinical value in diagnosis, differential diagnosis, the choice of operation methods and the assessment of treatment effect or prognosis in hepatic tumors.Material and Methods: In this study, 106 hepatic tumors (19 cases of benign tumors, 49 cases of hepatocelluiar carcinomas HCC and 38 cases of metastatic hepatocarcinomas MHC) were examined with CDFI, PW, CPA and 3D-CPA. The blood supply in peritumor and intratumor were observed and optimal images were stored inMO disc for serial analysis. In the 49 HCCs, 7 were small hepatocellular carcinomas(SHCCs, the diameter 3cm ). In the 38 MHCs, 13 were small metastatic heptocarcinomas(SMHCs, the diameter ^3cm). 49 tumors were excised operatively, 11 were benign and 38 were malignant. According to the staging criterion established on the Forth Chinese Liver Cancer Academic Conference, combining with the international TNM standard,, the 38 hepatocarcinomas excised operatively were categorized into clinic I-IIIstage : 9 cases of stage 1,22 cases of stage II and 7 cases of stage III. All cases, fasting 12 hours, supine or left lateral position, were examined. 2D grey-scale sonography was used to depict the size, outline, position of the tumors, and the adjacencies of the liver were also scanned. The blood flows intratumor and peritumor were detected with CDFI. The optional PW spectra were acquired with sample volume 2mm, angle between the sample line and blood flow less than 30. The kind of blood flow was determined by the spectra: the pulsatile was arterial flow and the continuous was portal vein flow. The peak systolic velocity (PSV), resistant index (RI) were measured and their maximum were recorded. The blood flows in the tumors were displayed with CPA and graded into I -III according to the blood flow distribution and degree of blood supply richness . The CPA mean color vessels density (MCVD) was calculated using computer software. Tumor vascularity wasreconstructed with 3D-CPA, their distribution was observed wholly and graded as the hypervasculanty and hypovascularity. The numbers of tumor vessels were counted and vascularity index (VI) was calculated as the numbers of vessels per unit volume. All the slices of tumor tissue specimens excised operatively were performed HE staing pathologic examine and immumohistochemistry using anti-CD34, anti- a -smooth muscle actin( a -SMA) monoclonal antibody and anti-factor- Vffl related antigen (F8RA ) polyclonal antibody. The MVDs were calculated separately. The results above were analyzed statistically.Results:(1)The pathological results of the 49 tumors excised showed that 11 were benign tumors(9 cavernous hemangiomas, 1 focal fatty denaturelization and 1 hepatic cirrhosis nodule), 38 were hepatocarcinomas (35 HCC, 1 cholangiocarcinoma , 2 mixed patterns and 1 uncertain original adenocarcinoma). Most cancerous cells were presented as irregular trabecular or pseudoglandular patterns with increased density and nucleusrcytoplasm ratio. The microvessels in cancerous tissues were compressed, stenosed or contorted, thrombsis could be found in some branches of portal veins. (2)Immunohistochemically, the membrane and plasma of the vessel endothelial cell(VEC),the media smooth muscle cell(SMC) in cancerous tissue were positively stained with CD34 ,F8RA and a -SMA, assessing the MVD were 63.31+29.93/400 X, 32.71+13.84/400 X and 26.38+11.43/400 X respectively. The peritumor cirrhosis tissues, benign...
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