Value of contrast-enhanced color Doppler sonography in diagnosing hepatocellular carcinoma with special attention to the "color-filled pattern".

PURPOSE: The purpose of this study is to evaluate the effectiveness of contrast-enhanced color Doppler sonography in the diagnosis of hepatocellular carcinoma (HCC), with special attention to the value of a "color-filled pattern." METHODS: Contrast enhancement with Levovist was performed on 30 liver tumors, including 21 HCCs, as part of phase II and III clinical trials. Detection of a "feeding artery" or a "color-filled pattern" with color Doppler sonography was interpreted as a positive finding for HCC. Angiography was also performed. RESULTS: A feeding artery was detected in 9 HCCs before contrast enhancement and 20 HCCs after. A color-filled pattern was seen in 14 HCCs after enhancement. A feeding artery was seen in only 1 non-HCC tumor, and a color-filled pattern was not seen in any non-HCC. The sensitivity and specificity of a feeding artery for the diagnosis of HCC were 95% and 89%, values similar to those of hepatic angiography. The sensitivity and specificity of a color-filled pattern were 67% and 100%, respectively. CONCLUSIONS: Contrast enhancement increases the detectability of a feeding artery and improves the sensitivity of color Doppler sonography for diagnosing HCC. A color-filled pattern is a highly specific finding in the diagnosis of HCC.

[Contrast enhanced color Doppler sonogram of liver tumors: a color-filled pattern in the late phase].

In the present report, a "color-filled pattern", the late phase effect in the intra-venous contrast enhanced color Doppler sonography is introduced, using SH/TA-508 as the contrast agent. This pattern is defined as an image of a tumor area filled with color in contrast to the surrounding liver. After contrast enhancement, the detectability of a "feeding artery" increased. And also "color filled pattern" appeared in 14 of the 21 hepatocellular carcinomas but none of the nine other liver tumors. In conclusion, contrast enhancement increases the detectability of a "feeding artery" and improves the sensitivity for HCC with color Doppler sonography. A "color-filled pattern" is also effective in the diagnosis of HCC because it requires no technical skill and shows high specificity.

Evaluation of routine sonography for early detection of pancreatic cancer.

The diagnostic accuracy of routine abdominal sonography for the detection of pancreatic cancer was examined. During the one-year period of 1994, sonographic examination of the upper abdominal region was performed 12,761 times on a total of 9410 patients for the screening of abdominal disorders. In 655 cases (7%) part of the pancreas could not be observed. Based on the "Diagnostic criteria for pancreatic cancer" published by the Japanese Society of Ultrasound in Medicine, sonographic finding was evaluated to be positive for pancreatic tumor in a total of 411 cases. At the end of 1995, 51 patients were proven to have pancreatic cancer, and 45 of these cases were ductal adenocarcinoma. In 26 cases the tumor was surgically resected. Fifty cases were true sonographic positives and one was a false negative. The sensitivity, specificity, overall accuracy, and positive and negative predictive values of sonography for pancreatic cancer were 98.0%, 95.9%, 95.9%, 12.2% and 100.0%, respectively. Among the 50 true positive cases, the tumor diameter was less than 1 cm in four (8%). In conclusion, the diagnostic accuracy of sonography for the detection of pancreatic cancer is sufficiently high. Therefore, a detailed study aimed at mass screening for pancreatic cancer using sonography as the main modality seems warranted as a countermeasure for the rapid increase of pancreatic cancer in Japan.

[Evolution of ultrasonographic diagnosis for early cancer].

Ultrasonography is the best method for the screening of early cancer of abdominal parenchymatius organ. No dead angle had been in this field with the convex prove. The compressing method with this convex probe to the two linear pancreatic duct is usefull to detect the clue for diagnosing the early or occult cancer of pancreas. New other hopeful method for the diagnose of early cancer of abdominal parenchymatous organ are a few color Doppler technique, such as power mode, contrast enhanced method and harmonic imaging.

Effectiveness of the cytologic examination of pure pancreatic juice in the diagnosis of early neoplasia of the pancreas.

BACKGROUND: The early diagnosis of pancreatic carcinoma through the use of traditional radiographic or ultrasonographic methods is extremely difficult. METHODS: To detect an early and potentially curable cancer of the pancreas, endoscopic retrograde pancreatography (ERP) and aspiration cytology of pure pancreatic juice were performed in 295 consecutive patients who had symptoms or findings that suggested pancreatic disease but in whom there was neither a pancreatic mass nor ductal stenosis. RESULTS: Positive cytologic results were obtained in 12 patients (4%). With the aid of intraoperative cytodiagnosis, all 12 early neoplasms of the pancreas were successfully resected. Of these 12 resected specimens, 4 were adenocarcinoma with minimal invasion, 3 were in situ adenocarcinoma and 5 were marked atypia. All 12 patients were alive with no evidence of recurrence for an average of 32 months after surgery. The 283 patients who had negative ERP-cytology results were observed, but no further cases of pancreatic cancer were found. CONCLUSIONS: Because ERP-cytology is simple to perform, safe, and reliable, it is useful in the diagnosis of patients who have early neoplasm of the pancreas.

Effectiveness of galactose-based intravenous contrast medium on color Doppler sonography of deeply located hepatocellular carcinoma.

The purpose of this study is to examine the effectiveness of intravenously injectable sonographic contrast medium for color Doppler sonographic diagnosis of deeply located hepatocellular carcinoma. Subjects were 7 hepatocellular carcinomas, an adenomatous hyperplasia and a hemangioma located more than 7 cm below the abdominal surface. Levovist, a galactose-based sonographic contrast medium was injected through median cubital vein as a phase-two clinical study, and the pre- and post-enhanced color Doppler sonographic findings of these lesions were compared. The incidence of the positive findings for hepatocellular carcinoma increased from 29% (2/7) to 86% (6/7) of hepatocellular carcinoma after contrast enhancement. Positive findings were 0% in other cases even after enhancement. Levovist brought a certain improvement in the visualization of the tumor vessel by color Doppler sonography without any noteworthy side effects. Contrast enhancement was useful for the diagnosis of liver lesions suspected to be hepatocellular carcinoma by ordinary sonography, but could not be confirmed by color Doppler sonography.

Cytologic examination of pancreatic juice for differential diagnosis of benign and malignant mucin-producing tumors of the pancreas.

BACKGROUND: A new clinical type of pancreatic tumor, the mucin-producing tumor, has been recognized recently. However, it is not always easy to distinguish benign from malignant tumors preoperatively. In this study, three different methods of differentiating mucin-producing tumors of the pancreas were compared. METHODS: Endoscopic ultrasonography, endoscopic retrograde pancreatography, and cytologic examination of pancreatic juice were performed in 14 patients who had mucin-producing pancreatic tumors (11 carcinomas and 3 adenomas). Pancreatic juice was collected endoscopically without papillotomy. RESULTS: The sensitivity, specificity, and overall accuracy of endoscopic ultrasonography were 82%, 90%, and 79%, respectively; those of endoscopic retrograde pancreatography were 91%, 91%, and 86%; and those of cytologic examination were 91%, 100%, and 93%. CONCLUSION: Cytologic examination of pancreatic juice was the best of these three methods for differentiating benign from malignant mucin-producing pancreatic tumors.

Hookwire localizer as an aid for ultrasonic detection of small liver nodules.

We applied a V-shaped localizer and evaluated its clinical usefulness in nine patients with small hepatic nodules less than 2 cm in diameter. A small hepatic nodule was punctured with a 21-gauge localization needle under ultrasonic guidance, and the V-shaped localizer was pushed into the nodule with a wire. The localizer could be observed as a strong echo line by ultrasonography and as a high-density bar by computed tomography (CT). By this method, it was possible to precisely localize the nodule. Intraoperative ultrasonography became less time-consuming, and resection of the nodules could be confirmed with low-kilovoltage radiography.

Small hepatocellular carcinoma: differentiation from adenomatous hyperplastic nodule with color Doppler flow imaging.

Liver nodules smaller than 25 mm in diameter (19 hepatocellular carcinomas [HCCs] and nine adenomatous hyperplastic nodules [AHNs]) were examined with color Doppler flow imaging and hepatic angiography. Angiography revealed a tumor vessel in eight (42%) of the 19 HCCs, while color Doppler flow imaging revealed an arterial pulsating afferent tumor vessel in 10 (53%) of the 19 HCCs but in none of the AHNs. In addition, color Doppler flow imaging revealed a constant-flow efferent tumor vessel continuing to a portal branch in 10 (53%) of the 19 HCCs but in none of the AHNs. In 15 (79%) of the 19 HCCs, a pulsating afferent tumor vessel or a constant-flow efferent tumor vessel or both were observed. Therefore, in this series, color Doppler flow imaging was of value in distinguishing between these two lesions.