• Keiko Korenaga, Masaaki Korenaga, Matakazu Furukawa, Takahiro Yamasaki, and Isao Sakaida.
• Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan. keikore@med.kawasaki-m.ac.jp
• J. Gastroenterol. 2009 Jan 1; 44 (7): 733-41.

ObjectiveWe investigated the usefulness of Sonazoid contrast-enhanced ultrasonography (Sonazoid-CEUS) in the diagnosis of hepatocellular carcinoma (HCC). The examination was performed by comparing the images during the Kupffer phase of Sonazoid-CEUS with superparamagnetic iron oxide magnetic resonance (SPIO-MRI).MethodsThe subjects were 48 HCC nodules which were histologically diagnosed (well-differentiated HCC, n=13; moderately differentiated HCC, n=30; poorly differentiated HCC, n=5). We performed Sonazoid-CEUS and SPIO-MRI on all subjects. In the Kupffer phase of Sonazoid-CEUS, the differences in the contrast agent uptake between the tumorous and non-tumorous areas were quantified as the Kupffer phase ratio and compared. In the SPIO-MRI, it was quantified as the SPIO-intensity index. We then compared these results with the histological differentiation of HCCs.ResultsThe Kupffer phase ratio decreased as the HCCs became less differentiated (P<0.0001; Kruskal-Wallis test). The SPIO-intensity index also decreased as HCCs became less differentiated (P<0.0001). A positive correlation was found between the Kupffer phase ratio and the SPIO-MRI index (r=0.839). In the Kupffer phase of Sonazoid-CEUS, all of the moderately and poorly differentiated HCCs appeared hypoechoic and were detected as a perfusion defect, whereas the majority (9 of 13 cases, 69.2%) of the well-differentiated HCCs had an isoechoic pattern. The Kupffer phase images of Sonazoid-CEUS and SPIO-MRI matched perfectly (100%) in all of the moderately and poorly differentiated HCCs.ConclusionSonazoid-CEUS is useful for estimating histological grading of HCCs. It is a modality that could potentially replace SPIO-MRI.

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