The Application Of Color Doppler Ultrasonography And Contrast-enhanced Ultrasound In Detecting Tumor Vessel Of Liver Neoplasm

Objection To study tumor vessel appearance and dynamic mechanism of hepatic carcinoma with color Doppler imaging(CDI).Methods The study included 107 patients with hepatic carcinoma proven by histopathology from 2004.3 to 2005.10. there were 79 men and 28 women (age range, 28~76 years; mean age, 52 years). there were 81 hepatocellular carcinoma 26 metastatic hepatic cancer(mono-focus, 59; many focus, 48). 77 patients had received Transcatheter Artery Chemoembolization for 1~3 times. Diagnostic gray-scale US was perform to assess position, number, size, boundary, internal echo of the tumor. The vascular pattern of each tumor was assessed by using CDFI and CDE.120 masses were examined with Doppler ultrasonography. The grading mode of the tumor vessel such as branch, insert, net, arteriovenous fistula (AVF) and the anomal appearance such as punctiform or short streak , stenosis, twists, vascular pool were observed with CDFI and CDE. The results were compared with that of DSA. The Doppler parameters including velocity of peak systolic(PS) and resistant index(RI) of them were studied. We also observed the vessel appearance and dynamic mechanism of the recurring tumor of 77 patients after TACE.Results①Detection of the anomal appearance and grading mode of the tumor vessel with CDFI and CDE conform to that with DSA (Kappa值=0.689,p<0.05), except for the punctiform or short streak type. Most anomal appearance and grading mode of the tumor vessel were detected in group of 5cm≤d≤10cm. Then the group of d>10cm. The group of d>10cm has the lowest detection rate.②Of the 120 masses, 664 spots were seleted. The average PS was 90±18.7cm/s and the average RI was 0.71±0.13. The more blood supple in the tumer, the higher was the PS. The PS of the twists and stenosis Type was higher than that of the punctiform or short streak type. The group of vascular pool have lowest PS. High RI was detected in all groups in which the vascular pool has the highest RI(0.83). Among the different grading mode vessel, the PS of AVF was highest, then was the branch and the insert type, and lastly was the net type (P < 0. 05). The RI of AVF was lowest(0.51).③New vessels were detected in 51 masses of 77 patients who have received TACE for two months. 35 masses were dectected vessel blood in the perimeter, 11 masses in the interior and 5 masses in both perimeter and interior. The most vessel appearance is punctiform or short streak type(72.5%). The PS of new tumor vessels was lower than that before TACE (p<0.05). But the RI no obvious change.Conclusions Color Doppler ultrasonography can clearly detect the anomal appearance and grading mode of the tumor vessel, which diverisify the parameter of the blood vessel dynamic mechanism. Objection To investigate the clinical value of real time gray-scale contrast ultrasonography for diagnosis and interventional treatment of liver neoplasm.Methods The study included 70 inpatients from 2005.3 to 2006.2. there were 59 men and 11 women (age range, 29~71 years; mean age, 51±13.6years). there were 37 hepatocellular carcinoma , 15 metastatic hepatic cancer, 8 hepatic angiomal, 3 focal nodular hyperplasia, 2 hepatic adenoma, 3 hepatophyma, 2 inhomogeneity adiposis hepatica (mono-focus, 56; many focus, 14). 78 masses were examined with new contrast agent (Sonvue) and Coded Harmonic Angio in the Logiq 9. The result were compared with that of routine ultrasonography and multi-slice spiral CT. We also examined 46 masses of 41 patients after TACE with contrast-enhanced ultrasonography. The result were compared with those of routine ultrasonography, multi-slice spiral CT and DSA.Results After contrast agent administration, 39 HCC presented with early artery enhancement and immediate wash out, while the other 3 cases of small ( < 3 cm) hyper-differentiated HCC washed out slowly, The enhancement pattern of 19 liver metastastic cases was diverse, including various degree peripheral or nodosity enhancement in the arterial or portal phase with slow or fast wash out. The 9 cases of haemangioma were enhanced centripetally in later arterial phase and washed out after more than 3 minutes. 3 FNH were enhanced centrifugally in arterial phase and kept enhancing in portal phase and parentchymal phase. 2 hepatic adenoma had the similar enhancement patten to that of HCC. The 2 cases of hepatophyma were enhanced peripherally with point and little nodosity mode. 2 inhomogeneity adiposis hepatica had the similar enhancement patten to that of sourrounding liver parenchyma. The numbers of the focus were detected with contrast-enhanced ultrasonography more than that with routine ultrasonography and multi-slice spiral CT. Fourty-six lesions of 41 patients were observed with contrast-enhanced ultrasonography after interventional treatment. The result were compared with those of multi-slice spiral CT and DSA. There were no significant statistically(p>0.05).Conclusions Color Doppler can clearly detect the anomal appearance and grading mode of the tumor vessel,which diverisify the parameter of the blood vessel dynamic mechanism.