Intervirology 2008;51:61–69

Differential Diagnosis of Hepatic Tumors: Value of Contrast-Enhanced Harmonic Sonography Using the Newly Developed Contrast Agent, Sonazoid

Hatanaka K.a · Kudo M.a · Minami Y.a · Ueda T.a · Tatsumi C.a · Kitai S.a · Takahashi S.a · Inoue T.a · Hagiwara S.a · Chung H.a · Ueshima K.a · Maekawa K.b
aDivision of Gastroenterology and Hepatology, Department of Internal Medicine, and bAbdominal Ultrasound Unit, Kinki University School of Medicine, Osaka-Sayama, Japan
email Corresponding Author

 goto top of outline Key Words

  • Contrast-enhanced harmonic ultrasonography
  • Hepatic tumors
  • Intranodular hemodynamics
  • Intratumoral perfusion
  • Sonazoid
  • Ultrasonography

 goto top of outline Abstract

Objective: To clarify the value of contrast-enhanced harmonic ultrasonography (US) with Sonazoid, a second-generation US contrast agent, in the differential diagnosis of liver tumors compared to dynamic CT. Methods: A total of 249 hepatic nodules in 214 patients were studied; these included 177 hepatocellular carcinomas (HCCs), 42 liver metastases, 20 liver hemangiomas, 6 dysplastic nodules and 4 focal nodular hyperplasias (FNHs). After the injection of Sonazoid, nodules were scanned using real-time contrast-enhanced harmonic US in the vascular phases, i.e. the early and late vascular phases, and the Kupffer phase. Results: Six enhancement patterns were identified to be significant for the differential diagnosis of hepatic tumors. In HCCs, the presence of intratumoral vessels supplied from the periphery and fast washout (sensitivity, 96.6%; specificity, 94.4%) were the most typical characteristics. In metastases, the presence of rim-like enhancement with peripheral tumor vessels (sensitivity, 88.1%; specificity, 100%) was the typical pattern. In hemangiomas, the presence of intratumoral hypoperfusion images with globular or cotton wool-like pooling, which continue to the late vascular phase (sensitivity, 90.0%; specificity, 99.6%), was typical. In dysplastic nodules, the presence of portal enhancement without arterial supply in the early vascular phase and the presence of intratumoral uptake in the Kupffer phase (sensitivity, 83.3%; specificity, 100%) were the most typical patterns. In FNHs, the presence of a spoke-wheel pattern in the early vascular phase with dense staining in the late vascular phase, and positive uptake within the nodule in the Kupffer phase (sensitivity, 100%; specificity, 100%) were the most typical patterns. Conclusion: Contrast-enhanced harmonic US with Sonazoid allowed intimate vascular and Kupffer imaging and, therefore, is useful for the differential diagnosis of hepatic tumors.

Copyright © 2008 S. Karger AG, Basel

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 goto top of outline Author Contacts

Masatoshi Kudo, MD, PhD
Division of Gastroenterology and Hepatology, Department of Internal Medicine
Kinki University School of Medicine, 377-2 Ohno-Higashi
Osaka-Sayama 589-8511 (Japan)
Tel. +81 72 366 0221, Fax +81 72 367 2880, E-Mail

 goto top of outline Article Information

Published online: June 10, 2008
Number of Print Pages : 9
Number of Figures : 6, Number of Tables : 0, Number of References : 20

 goto top of outline Publication Details

Intervirology (International Journal of Basic and Medical Virology)

Vol. 51, No. Suppl. 1, Year 2008 (Cover Date: June 2008)

Journal Editor: Liebert U.G. (Leipzig)
ISSN: 0300–5526 (Print), eISSN: 1423–0100 (Online)

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