Volume 41, Issue 3, Pages 421-426 (September 2004) Usefulness of contrast-enhanced perfusional sonography in the assessment of hepatocellular carcinoma hypervascular at spiral computed tomography  Stefano Gaiani, Natascia Celli, Fabio Piscaglia, Laura Cecilioni, Franco Losinno, Francesco Giangregorio, Mikaela Mancini, Patrizia Pini, Fabio Fornari, Luigi Bolondi  Journal of Hepatology  Volume 41, Issue 3, Pages 421-426 (September 2004) DOI: 10.1016/j.jhep.2004.04.022

Fig. 1 Enrollment design of cirrhotic patients with focal liver lesions included in study. According to inclusion criteria, 41/110 patients were excluded due to multifocal or infiltrating tumors, portal vascular invasion, decompensated liver disease or absence of arterial hypervascularity at spiral CT. *Screening surveillance program included 850 cirrhotic patients. **Data refer to nodules observed at US examination. Journal of Hepatology 2004 41, 421-426DOI: (10.1016/j.jhep.2004.04.022)

Fig. 2 Diagnostic work-up of liver nodules was based on presence of hypervascular pattern at spiral CT and confirmed by second imaging modalities (Doppler US or MRI) or by AFP levels ≥400 ng/ml. US-guided biopsy was performed in 15 cases in whom above-mentioned criteria were not satisfied. Of 103 nodules that were hypervascular at spiral CT, 94 (91.3%) were positive at contrast-enhanced perfusional sonography. Journal of Hepatology 2004 41, 421-426DOI: (10.1016/j.jhep.2004.04.022)

Fig. 3 Vascular pattern of HCC at contrast-enhanced perfusional sonography. At baseline US (A), the nodule is slightly hyperechoic with hypoechoic halo. In arterial phase (B, C and D, corresponding to 23, 25 and 28 s after injection of 2.5 ml of SonoVue) the nodule shows progressive and homogeneous enhancement. In subsequent portal (E=48s) and parenchymal phases (D=94s), due to perfusion of surrounding liver parenchyma together with wash-out of contrast agent from the nodule, it appears isoechoic and less evident. Journal of Hepatology 2004 41, 421-426DOI: (10.1016/j.jhep.2004.04.022)