Doppler Sonagram & HCC

liver411

December 2001 . Volume 34 . Number 6



Original Articles



Contrast-enhanced doppler ultrasonography in the diagnosis of hepatocellular carcinoma and premalignant lesions in patients with cirrhosis



        Anna Ludovica Fracanzani1 Larry Burdick1 Mauro Borzio2

        Massimo Roncalli3Nicola Bonelli4 Franco Borzio2 Alessandra

        Maraschi1 Gemino Fiorelli1 Silvia Fargion1







Hepatocellular carcinogenesis in cirrhosis is a multistage process that

includes large regenerative nodules, dysplastic nodules, and

hepatocarcinoma. The aim of this study was to establish whether

contrast-enhanced Doppler ultrasonography (US) is able to distinguish

between early hepatocellular carcinoma (HCC) and small nonmalignant nodules in cirrhosis. Between January 1998 and December 1999, 500 cirrhotic patients with no previous history of HCC or evidence of hepatic focal lesions were enrolled and prospectively followed-up with US every 6 months until December 2000. Sixty-one patients developed focal lesions, 12 multifocal, and 49 monofocal. Biopsy of focal lesions, contrast-enhanced Doppler US, and spiral computed tomography (CT) were performed in 41 consecutive patients with small (<3 cm) monofocal lesions. Twenty nodules were diagnosed as HCC and 21

as nonmalignant (14 large regenerative nodules, 3 low-grade, and 4

high-grade dysplastic nodules) by liver biopsy. Intratumoral arterial blood flow was detected in 19 of 20 (95%) HCC and 6 of 21 (28%) nonmalignant nodules by contrast-enhanced Doppler US (P<.0001). The mean peak resistance and pulsatility indices were 0.82 ± 0.09 and 1.56 ± 0.2 in HCC and 0.62 ± 0.08 and 0.82 ± 0.08 in dysplastic lesions (P = .002 and .0001), respectively. Spiral CT revealed arterial perfusion in 19 of 20 HCC and in 4 of 21 nonmalignant nodules (high-grade dysplastic nodules). Four of the apparently false-positive nodules at enhanced Doppler US were high-grade dysplastic nodules and 2 evolved to HCC during follow-up. In conclusion, contrast-enhanced Doppler US is a noninvasive, very sensitive technique in

differentiating malignant and premalignant lesions from nonmalignant focal lesions in the liver.

(HEPATOLOGY 2001;34:1109-1112.)