Contrast-enhanced Color Doppler Ultrasonography Research Articles

Determination of peripheral color signal density using contrast-enhanced color Doppler ultrasonography in diffuse liver disease.

The study aimed to quantify hepatic vascular changes that accompany the development of chronic liver disease using contrast-enhanced color Doppler ultrasonography and histopathological examination. A series of 62 patients with biopsy-proven chronic liver disease (31 chronic hepatitis, 31 liver cirrhosis) and 8 healthy controls were studied. Altogether, 22 livers (9 chronic hepatitis, 13 liver cirrhosis) obtained at surgery or autopsy were subjected to histopathological examination. Patients with cardiopulmonary disease or intrahepatic tumors were excluded. Intrahepatic color Doppler signals were scanned and counted at the liver surface in a 10 × 30 mm rectangle from liver segment V using color Doppler sonography (SSA 380 A) before and after contrast enhancement with SHU 508A (Levovist). Small arteries 30-1000 µm in diameter were counted on the histopathlogical specimen by microscopy. The number of color Doppler signals increased significantly after contrast enhancement in both patients and controls. The number of color Doppler signals was elevated before and after contrast enhancement when chronic liver disease was present, especially in cases of Child-Pugh grade C liver cirrhosis. Histologically, more arteries 30-125 µm in diameter were present in patients with chronic hepatitis than in those with liver cirrhosis, whereas more arteries ≦ 125 µm in diameter were present in patients with liver cirrhosis than in those with chronic hepatitis. Intrahepatic color Doppler signals are probably derived from peripheral arteries larger than 125 µm in diameter, and the signal density in these arteries increases with progression of the chronic liver disease.

Radiofrequency ablation of liver cancer: early evaluation of therapeutic response with contrast-enhanced ultrasonography.

The early assessment of the therapeutic response after percutaneous radiofrequency (RF) ablation is important, in order to correctly decide whether further treatment is necessary. The residual unablated tumor is usually depicted on contrast-enhanced multiphase helical computed tomography (CT) as a focal enhancing structure during the arterial and portal venous phases. Contrast-enhanced color Doppler and power Doppler ultrasonography (US) have also been used to detect residual tumors. Contrast-enhanced gray-scale US, using a harmonic technology which has recently been introduced, allows for the detection of residual tumors after ablation, without any of the blooming or motion artifacts usually seen on contrast-enhanced color or power Doppler US. Based on our experience and reports in the literature, we consider that contrast-enhanced gray-scale harmonic US constitutes a reliable alternative to contrast-enhanced multiphase CT for the early evaluation of the therapeutic response to RF ablation for liver cancer. This technique was also useful in targeting any residual unablated tumors encountered during additional ablation.

Contrast-enhanced transrectal color Doppler ultrasound for assessment of tumorangiogenesis in prostate cancer

Objective: The clinical relevance of tumor angiogenesis has been investigated in several human tumors, including prostate carcinoma (PC). Previously, we found angiogenesis, measured as microvessel density (MVD), to be an independent prognostic factor in PC. Therefore, we evaluated contrast-enhanced transrectal color Doppler ultrasound (CDUS) for assessment of tumorangiogenesis in PC. Methods: We investigated 12 patients with PC detected on contrast-enhanced CDUS targeted biopsy. Transrectal CDUS was performed using a microbubble-based ultrasound enhancer SonoVue for identifying hypervascularized areas within the peripheral zone of the prostate. Computer-assisted quantification of color pixel intensity (PI) was used to evaluate objectively the hypervascularized areas. MDV was determined by light microscopy. We highlighted the vessels by staining their endothelial cells immunohistochemically using a monoclonal antibody against the CD31 antigen. Microvessels were carefully counted at ×400 magnification. CDUS findings were correlated with the immunohistochemical data. Results: Analysis of contrast-enhanced CDUS data and immunohistochemistry revealed a significant correlation between PI and MVD in PC specimens, demonstrating a correlation coefficient of r2 = 0.94 (p<0.001). Conclusions: Assessment of PI by contrast-enhanced transrectal CDUS correlates significantly with MVD. Therefore, quantification of color Doppler signals seems to be helpful for assessment of tumorangiogenesis in PC.

Radio-frequency ablation of VX2 rabbit tumors: assessment of completeness of treatment by using contrast-enhanced harmonic power Doppler US.

To assess contrast material-enhanced harmonic power Doppler and fundamental color Doppler ultrasonography (US) in the detection of residual viable tumor tissue after radio-frequency (RF) ablation in tumors embedded in fat. Twenty-eight VX2 tumors were implanted into the retroperitoneum of 14 rabbits. Tumors were examined with contrast-enhanced fundamental color Doppler US and harmonic power Doppler US before and 10 minutes after RF ablation. Saline-enhanced RF ablation (30 mL/h) was performed over 10 minutes with 28-W RF power. Follow-up included repeat US examinations. Necropsies and histopathologic assessment were performed after detection of residual untreated tumor at US or 3 weeks after ablation. VX2 tumors reached a mean size of 21 mm +/- 9 (SD) (size range, 6-43 mm) 25 days after implantation. All tumors larger than 31 mm showed signs of central necrosis at US. Before ablation, intense vascularity was detected in all tumors with both contrast-enhanced US modes. Histopathologic assessment at the end of the follow-up period revealed local relapses due to incomplete ablation in 14 (50%) of 28 cases. Detection of residual tumor was missed in all cases with contrast-enhanced color Doppler US. Contrast-enhanced harmonic power Doppler US depicted residual flow in 12 of the 14 cases (sensitivity, 86%) in which local relapses occurred. There was a significant (P <.005, McNemar test) improvement in detection of residual tumor when the harmonic power Doppler mode was used. Contrast-enhanced harmonic power Doppler US has greater sensitivity than contrast-enhanced color Doppler US for detecting residual VX2 tumor following ablation. Therefore, contrast-enhanced harmonic power Doppler US may be a useful additional method for the detection of residual tumors after RF ablation.

Correlation between microbubble contrast-enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: preliminary results.

The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist. Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings. Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue. Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.

Contrast-enhanced ultrasonography using levovist: Usefulness of diagnosis of small focal nodular hyperplasia lesions.

Differential diagnosis of focal nodular hyperplasia and hepatocellular carcinoma is clinically important because, while both are hypervascular tumors, they have vastly different prognoses. Because the spoke-wheel appearance is the primary characteristic of focal nodular hyperplasia, we attempted to detect this pattern in nodules smaller than 3 cm in diameter with contrast-enhanced ultrasonography using a contrast agent (Levovist). Four patients were examined with contrast-enhanced US: two of the patients were examined with Coded Harmonic Angio; the other two patients were examined with contrast-enhanced color and power Doppler US without harmonic imaging. Although the hepatic arteriogram showed the spoke-wheel appearance in only one tumor (diameter, 3 cm), contrast-enhanced US clearly demonstrated this characteristic in all four tumors, including three tumors that were less than 2 cm in diameter. Because it is noninvasive and can be carried out in an outpatient clinic, contrast-enhanced US is extremely useful for diagnosing small focal noduler hyperplasia lesions at sites that can be observed with US.

Tumor vascularity: evaluation in a murine model with contrast-enhanced color Doppler US effect of angiogenesis inhibitors.

To determine the ability of contrast material-enhanced ultrasonography (US) to depict tumor growth and vascularity in a murine model of prostate carcinoma treated with an angiogenic inhibitor. Thirty-five genetically engineered mice with spontaneously occurring prostate tumors were monitored on a weekly basis with gray-scale and color Doppler US with a 15-MHz linear transducer. Eighteen mice were treated with an adenoviral vector to deliver a soluble form of the Flk1 receptor (VEGFR-2), a vascular endothelial growth factor receptor designed to block tumor angiogenesis. The remaining 17 animals were injected with saline and used as controls. Tumor volumes were calculated on the basis of serial US measurements. Color Doppler US was performed in every tumor before and after intravenous injection of 0.1 mL per kilogram of body weight of a US contrast agent. US images were evaluated for tumor size, pattern of vascularity, and extent of vascularity (vascularity index). Findings at US were correlated with findings at autopsy in 30 animals. Estimates of tumor volume at US correlated well with tumor measurements at autopsy (r =.89, P <.001). Marked differences in tumor size and slope of increasing tumor volume were evident at US between treated and control mice after treatment (P <.016, analysis of variance). The US contrast agent markedly increased color Doppler US signal intensity with an 800% (from 10% to 12,700%) change in the mean number of color pixels per imaging field, and showed vascularity in areas of tumor not identified on precontrast images in 70% (109 of 156 studies). No correlation was found between the pattern of vascularity or vascularity index before or after contrast material administration and tumor size, treatment status, or histologic assessment of tumor vascularity. Contrast-enhanced US improves visualization of tumor vascularity. However, histologic patterns of tumor vascularity do not correlate with Doppler US depiction of blood flow in these vessels.

Small hepatocellular carcinoma: therapeutic effectiveness of percutaneous radio frequency ablation therapy with a LeVeen needle electrode.

To evaluate the therapeutic effectiveness of percutaneous radio frequency ablation of small (< or =3-cm) hepatocellular carcinoma with a LeVeen needle electrode. Thirty patients (mean age, 65.7 years) with 32 hepatocellular carcinomas (range, 1.2-3.0 cm; mean, 2.3+/-0.5 cm) underwent percutaneous radio frequency ablation to the center of the hepatocellular carcinoma after expansion of the inner needles. The manufacturer's recommended radio frequency ablation protocol was used. Posttreatment contrast-enhanced color Doppler sonography, contrast-enhanced computed tomography, and fine-needle biopsy were performed to assess the radio frequency ablation-induced coagulated necrosis. Severe intratreatment pain made us abort radio frequency ablation in 2 patients. Complete tumor necrosis was achieved in 1 treatment session with 1 needle electrode insertion in 28 (93.4%) of 30 nodules (28 patients). We found no residual focus on both color Doppler sonography and computed tomography after any of the sessions. In follow-ups ranging from 3 to 15 months (mean, 8.4 months), no local recurrence was found in cases with complete tumor ablation. Radio frequency ablation with the LeVeen needle electrode was effective, obtaining complete coagulated necrosis with a safety margin when used for the treatment of small hepatocellular carcinomas.

Changes of tumor vascularity during gene therapy monitored with color Doppler us

Using contrast-enhanced color Doppler (CD) sonography, we assessed alterations of tumor blood flow induced in 25 murine Morris hepatomas transfected with a gancyclovir- (GCV-)sensitizing Herpes simplex virus thymidine kinase (HSVtk) suicide gene in combination with systemic GCV treatment and compared findings with a control tumor. CD measurements were quantified by the color pixel density (CPD) and the mean encoded flow velocity (mean color value, MCV), using computer-assisted image analysis, and compared with histologic arteriole counts. During 5 days, the tumor volume remained constant. In HSVtk-expressing tumors, the median CPD dropped from 16% at baseline to 5% on day 5 ( p = 0.001), remaining constant in controls. The MCV decreased from 1.9 cm/s to 1.6 cm/s in the HSVtk-expressing tumors ( p = 0.001) and rose from 1.8 cm/s to 2.0 cm/s in the controls ( p = 0.002). In an accompanying histologic arteriole assay, we found no alterations attributable to treatment. (E-mail: s.delorme@dkfz.de)

Hepatocellular carcinoma: evaluation of the effectiveness of percutaneous ethanol injection under real-time contrast-enhanced color doppler ultrasonography with contrast agent levovistTM

Hepatocellular carcinoma: evaluation of the effectiveness of percutaneous ethanol injection under real-time contrast-enhanced color doppler ultrasonography with contrast agent levovistTM

Hepatocellular carcinoma: evaluation of the effectiveness of percutaneous ethanol injection under real-time contrast-enhanced color doppler ultrasonography with contrast agent levovistTM

Hepatocellular carcinoma: evaluation of the effectiveness of percutaneous ethanol injection under real-time contrast-enhanced color doppler ultrasonography with contrast agent levovistTM

Evaluation of contrast-enhanced color Doppler ultrasound for the quantification of angiogenesis in vivo.

To evaluate contrast-enhanced color Doppler ultrasonography (CDUS) aimed at quantifying angiogenesis in vivo. Eight colon tumors xenografted into mice were studied with CDUS both without and after injection of SHU 508A. The number of intratumor vessels and pedicles visualized with CDUS and the value of the acoustic intensity quantified by computer were compared with the evaluation of angiogenesis by study of digitized histological slides. SHU 508A increased the number of intratumor vessels and pedicles depicted by CDUS, which could also be quantified by acoustic intensity. The comparison of CDUS and digitized histological slide studies showed that the detection threshold after SHU 508A administration allowed visualization of small vessels (40 microm in diameter). The "hot spots" seen on histology were superimposable onto vessels seen with CDUS. Regions in which no vessels were detected by CDUS corresponded to regions in which vascularization was absent by histological analysis. Injection of SHU 508A significantly increased vessel detection with CDUS.

The Use Contrast-Enhanced Color Doppler Ultrasonography in the Detection of Hepatocellular Carcinoma-Related Vessels

Purpose: To assess the value of contrast-enhanced color Doppler ultrasonography(US) in the detection of ves-sels related to hepatocellular carcinoma(HCC).Materials and Methods: Between July 1997 and April 2000, 76 HCCs in 70 patients (50 men and 20 women; mean age, 57.8 years) were confirmed histologically or clinically. Tumor site and size at gray scale US, and afferent, intratumoral and efferent color signals at precontrast and postcontrast color Doppler US were deter-mined. Afferent signals were classified as basket or penetrating type, and intratumoral signals as spotty, linear or mixed. Efferent signals were categorized as signal to portal vein or signal to hepatic vein, and postcontrast color signal changes as focal, general or marginal spotty type. We also measured the color percentage of intra-tumoral signals as seen during precontrast and postcontrast study.Results: The detection rate changed from 41(53.9%) to 60(78.9%) in cases with afferent signals, from 50(65.8%) to 64(84.2%) in those with intratumoral signals, and from 6(7.9%) to 9(11.8%) in those with efferent signals. Overall, 74(97.4%) cases showed positive findings at postcontrast color Doppler US. The most common enhancing pattern was general, occurring in 33(43.4%) cases. The color percentage of intratumoral signals increased from an average of 8.2% to 34.9%. The detection rate of intratumoral signals from tumors less than 3 cm in diameter increased from 56.8% to 100%, and that of deeply-located tumor-related signals (17 cas-es) increased from 47.1% to 94.1%.Conclusion: The use of contrast enhanced color Doppler US increased the detection rate of afferent, intratumoral, and efferent signals, especially that of intratumoral signals from tumors less than 3 cm in diameter and signals from deeply located tumors. In addition, the modality can aid the diagnosis of HCC by evaluating tumor dynamics.

Perfusion abnormalities of kidney parenchyma: microvascular imaging with contrast-enhanced color and power Doppler ultrasonography--preliminary results.

The purpose of this study was to evaluate the feasibility of microvascular imaging using contrast-enhanced color and power Doppler sonography. Ten patients with a focal lesion of the kidney were examined. Three patients were investigated with the polymeric butylcyanacrylate-based contrast agent SHU 563A, and the remaining patients were investigated with the galactose-based agent Levovist. It was possible to observe the microvascularization with Levovist during the blood pool phase of the agent over a period of 1 to 3 s at 1 min and 2 min after injection. With SHU 563A, microvascular imaging was possible 0.50 s after injection and lasted for 10.35 min. No intratumoral signals were seen in cysts (n = 6) and the investigated abscess. Weak intratumoral polychromatic effects were observed in both renal cell carcinomas in this series. Metastasis could be differentiated from healthy parenchyma due to lack of the polychromatic effect. SHU 563A is appropriate for performing microvascular imaging. The Levovist-induced polychromatic effects are smaller, of shorter duration, and observable only during the blood pool phase; thus, the expected diagnostic benefit is limited.

Contrast-Enhanced color doppler US in malignant portal vein thrombosis

To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis. Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis. Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%. Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.

Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors.

We determined whether contrast-enhanced color Doppler sonography can differentiate benign from malignant enlarged cervical lymph nodes in head and neck tumors. Ninety-four enlarged lymph nodes in 39 adult patients (32 men and seven women; age range, 30-81 years) were examined with B-mode sonography and with unenhanced and contrast-enhanced color Doppler sonography. All patients had carcinoma of the oral cavity. Histologically, lymphadenitis was found in 57 nodes and metastases in 37 nodes. Geometric dimension, texture, and margin of the node and detection and location of vessels were noted. Histology and imaging findings were correlated. The transverse-to-longitudinal diameter ratio in combination with texture and margin analysis resulted in a correct diagnosis in only approximately 79% of the nodes. With contrast-enhanced color Doppler sonography, 86% of nodes showed vessels, and 28% of nodes showed vessels with this technique exclusively. Characteristic configurations were identified: hilar vessels with branching indicated lymphadenitis (sensitivity, 98%; specificity, 100%), and predominantly peripheral vessels indicated metastases (100%, 98%). These findings changed the diagnosis in 13 nodes, changed the therapy in four patients, and led to an incorrect diagnosis in one patient. Enlarged lymph nodes can be characterized as metastatic or inflammatory with high diagnostic accuracy on the basis of their vascular architecture as seen on contrast-enhanced color Doppler sonography.

Clinical evaluation of contrast‐enhanced color Doppler sonography in the differential diagnosis of liver tumors

Purpose We investigated the value of contrast-enhanced color Doppler sonography in the differential diagnosis of liver tumors. Methods We prospectively examined 105 focal liver lesions in 100 patients by real-time gray-scale sonography, color Doppler sonography, and contrast-enhanced color Doppler sonography with galactose-based microbubbles (SH U 508A; Levovist). The final diagnoses of the liver lesions as confirmed by pathology or additional imaging techniques were 31 metastases, 25 hemangiomas, 19 hepatocellular carcinomas, 19 focal nodular hyperplasias, 2 cholangiocellular carcinomas, and 9 other lesions. Results Vascularity could be detected in 43 (41%) of the 105 lesions by conventional color Doppler sonography compared to 67 (64%) by contrast-enhanced color Doppler sonography. Contrast-enhanced color Doppler sonography identified moderate or extensive vascularity in all 19 focal nodular hyperplasias, moderate or extensive vascularity in 16 hepatocellular carcinomas and both cholangiocellular carcinomas, and no or minor vascularity in all but 3 hemangioma. The combination of gray-scale, conventional color Doppler, and contrast-enhanced color Doppler sonography led to the correct diagnosis in 81% of cases (85 of 105), compared to 57% (60/105) for gray-scale and conventional color Doppler sonography and 31% (33/105) for gray-scale sonography alone. Conclusions Contrast-enhanced color Doppler sonography improves the detection of tumor vascularity and is useful in the differential diagnosis of liver lesions. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:1–13, 2000.

Hepatocellular carcinoma treated with chemoembolization: assessment with contrast-enhanced doppler ultrasonography.

To report our preliminary experience concerning the use of Doppler ultrasonography (DUS) techniques after intravenous injection of the galactose-based contrast agent Levovist in the assessment of hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). The sonographic findings are correlated with those obtained using iodized oil (Lipiodol) helical computed tomography (CT). For 7 months we studied 28 patients with cirrhosis and HCC (a total of 43 nodules) who had undergone TACE between 18 and 30 days previously. The lesions were investigated with color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS), before and after infusion of the echo-contrast agent (300 mg/ml, maximum 1 injection for each nodule, administered at constant velocity within 60-90 sec), and with helical Lipiodol-CT (0-7 days after DUS). In the retrospective analysis, special attention was given to the Doppler signals related to pulsatile intra- and perinodular flow and to the detection of new vessels after contrast agent injection. The signal intensity was graded as 0 (absent), 1 (low), 2 (medium), or 3 (high), while its distribution was classified as peripheral, central, or diffuse. Oily agent retention on CT scans was assessed as 0 (absent), I (<10%), II (<50%), III (>50%), or IV (homogeneous). These scores were awarded separately, without knowledge of the other judgments. An hepatic global echo-enhancing effect was identified in all cases and always lasted long enough to allow an accurate analysis of all parenchymal lesions (at least 8 min). The signal scores could be evaluated in 39 of 43 HCCs, as follows: basal CDUS: grade 0 in 17 lesions, grade 1 in 16, grade 2 in 6; contrast-enhanced CDUS: grade 0 in 12 lesions, grade 1 in 10, grade 2 in 14, grade 3 in 3; basal PDUS: grade 0 in 15 lesions, grade 1 in 13, grade 2 in 9, grade 3 in 2; contrast-enhanced PDUS: grade 0 in 11 lesions, grade 1 in 9, grade 2 in 15, grade 3 in 6. Lipiodol-CT scoring was: grade 0 in 1 lesion, grade I in 7, grade II in 11, grade III in 9, grade IV in 11. In all but one nodule the difference between CDUS and PDUS scores, compared both with each other and with nonenhanced and contrast-enhanced examinations, was never greater than one grade. Contrast-enhanced DUS is a simple and fast procedure allowing a valuable, constant echo-enhancing effect of sufficient duration. DUS techniques, especially contrast-enhanced PDUS, offer an effective and realistic analysis of HCC nodules treated with TACE and show more evident agreement with Lipiodol-CT findings than baseline studies.

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

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." 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. 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. 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.