Real-time Contrast Enhanced Ultrasound In Diagnosis Of Hepatic Tumors And In The Evaluation Of The Information Of MVD In HCC Lesion

Objective1. To investigate the role of real time contrast-enhanced ultrasound in the evaluation of the perfusion and echogenicity of liver neoplasms and to discuss the diagnostic value.2. To study the correlation between the peak time(Tmax) on contrast- enhanced ultrasound and tumor microvessel density(MVD),to explore the potency of HCC for evaluating biological features of HCC.Methods1. Forty five patients(24 men, 21 women) with 63 tumors, which were confirmed by pathological findings,were examined by RTCEUS at low MI (0.05–0.08) after intravenous injection of SonoVue.The results were recorded and compared with that from baseline ultrasound.2. Thirty-four cases of hepatocellular carcinoma (HCC) diagnosed pathologically in operation or puncturation underwent contrast- enhanced ultrasonographic examination,and the peak time of all the cases was recorded by drawing the time-intensity curves. All HCC tissue samples were graded pathologically by HE staining. The microvessels were counted by using immunostaining with anti-CD34 antibody, and the differences of these parameters in the hepatocellular carcinoma were compared,and the correlation between Tmax and MVD was analyzed.Results1. The recall ratio of baseline ultrasound and RTCEUS was 87.3% and 96.8% respectively. For the tumors whose maximum diameter were under 1.0 cm, the recall ratio of baseline ultrasound and RTCEUS was 58.3 % and 16.7% respectively. 52.4%(33/63)tumors'edge was shown unclearly when observed through baseline ultrasound, while for the RTCEUS, only 6.3%(4/63)tumors'edge was not shown clearly. The sensitivity, specificity and accuracy of baseline ultrasound in diagnosing malignant tumor of liver was 51.4%,66.7% and 56.4%. As for RTCEUS, they were 95.3%,94.4% and 95.1%. The difference was statistically significant(P <0.05).2. Of 34 patients, 6 cases were diagnosed as well-differentiated, 15 cases as moderately differentiated, and the remaining 13 cases as poorly differentiated. MVD in the group of well-differentiated, moderately differentiated and poorly differentiated was 43.5±12.9,67.2±13.3,and 82.1±17.8, respectively. And Tmax in the three groups was (33.0±5.1) s, (27.7±4.2) s, and (22.7±3.3) s, respectively. MVD with differentiations was found to have statistic significance(F=13.46, P =0.001), and the Tmax in the three groups was statistically significant (F=14.08, P <0.001). Tmax was inversely correlated with MVD (Y = -0.16 X + 37.9, r = -0.605, P < 0.0001).Conclusion1. RTCEUS can provide much information about the number, size and edge of hepatic tumors than baseline ultrasound can do. It is sensitive and effective in the qualitative diagnosis of hepatic tumors2. The peak time of HCC on contrast-enhanced ultrasound can indirectly reflect the information of MVD in HCC lesion, which may be applicable to histological grading of HCC.