Use of hepatic tumor index on color Doppler sonography for differentiating large hepatic tumors.

Abstract

Color flow patterns on Doppler sonography are nonspecific for differentiating various hepatic tumors. We previously reported that a tumoral peak systolic flow velocity of 0.40 m/sec or greater suggested a malignant hepatic tumor rather than a hemangioma. However, tumoral peak systolic flow velocity failed to differentiate hepatocellular carcinomas and metastatic tumors. In this study, we attempted to assess the value of the hepatic tumor index for differentiating hepatocellular carcinomas and other hepatic tumors. Color Doppler sonography was performed in 80 patients with 108 hepatic lesions larger than 2.0 cm in diameter. The hepatic tumor index was calculated as the ratio of the tumoral peak systolic velocity to the peak systolic velocity of the right or left hepatic artery. Pulsatile color flow images were obtained in 42 of 48 hepatocellular carcinomas, 25 of 32 hepatic metastases, and 13 of 28 hemangiomas. The mean hepatic tumor indexes obtained from hepatocellular carcinomas, metastases, and hemangiomas were 1.14 +/- 0.37 (+/-SD), 0.63 +/- 0.22, and 0.60 +/- 0.17, respectively. The hepatic tumor indexes of hepatocellular carcinomas significantly exceeded those of metastases and hemangiomas (p < .01 in both cases). A hepatic tumor index equal to or greater than 1.0 was associated with 76% sensitivity, 92% specificity, and 82% accuracy in distinguishing hepatocellular carcinomas from hepatic metastases. In lesions with a tumoral peak systolic velocity of 0.40 m/sec or greater, a hepatic tumor index equal to or greater than 1.0 was associated with 91% sensitivity, 83% specificity, and 89% accuracy in distinguishing hepatocellular carcinomas from hepatic metastases. The hepatic tumor index on color Doppler sonography was useful in differentiating large hepatocellular carcinomas from hepatic metastases.