Hepatocellular Carcinoma: Depiction of Tumor Parenchymal Flow with Intermittent Harmonic Power Doppler US during the Early Arterial Phase in Dual-Display Mode

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Abstract
PURPOSE: To assess the effectiveness of contrast material–enhanced intermittent harmonic Doppler ultrasonography (US) in depicting tumor vessels and tumor parenchymal flow (stain) in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty-eight patients with 65 HCC nodules were examined by using intermittent harmonic power Doppler US and digital subtraction harmonic B-mode US, both with intravenous administration of SH U 508A. Vascular findings at early arterial phase harmonic US were classified as positive enhancement or nonenhancement, depending on the tumor vascularity relative to the surrounding liver parenchyma. These results were compared with those of three-phase helical dynamic computed tomography (CT). RESULTS: For hypervascular HCCs, there was excellent depiction of tumor vessels and tumor stain with the two intermittent harmonic US methods. The sensitivity and specificity for depiction of tumor vascularity were 93% (41 of 44 nodules) and 100% (21 of 21), respectively, with intermittent harmonic power Doppler US and 86% (38 of 44) and 100% (21 of 21), respectively, with subtraction US, as compared with these values at dynamic CT. Attenuation was an important factor in the depictability of tumor vascularity at harmonic US. CONCLUSION: Contrast-enhanced intermittent harmonic US enables noninvasive demonstration of tumor vessels and especially tumor stain in HCC.