Power Doppler sonography assessment of tumor recurrence after chemoembolization therapy for hepatocellular carcinoma.

Abstract

This study was undertaken to determine the value of power Doppler sonography in the evaluation of recurrent hepatocellular carcinomas after transcatheter arterial chemoembolization therapy.
Forty-five patients (age range, 45-81 years; mean age, 61 years) with hepatocellular carcinomas prospectively underwent power Doppler sonography, helical CT, and intraarterial digital subtraction angiography before and after transcatheter arterial chemoembolization therapy to evaluate for tumor recurrence. Three to 6 months after transcatheter arterial chemoembolization therapy, the Doppler signal, its location, and shape were evaluated. The results were compared with tumor vascularity as determined on helical CT and intraarterial digital subtraction angiography, which were used as the gold standards (n = 142).
A sonographic signal was seen in 80 of 142 lesions with power Doppler sonography. Flow signal in lesions tended to be more difficult to detect in the left lobe (sensitivity, 74%) than in the right lobe (sensitivity, 93%). The location of the color signal was in the tumor's center, on its periphery, or both. No correlation between tumor recurrence and the location of a signal within a tumor was found. Power Doppler sonography had a sensitivity of 87%, a specificity of 85%, and an accuracy of 86% in revealing tumor recurrence after transcatheter arterial chemoembolization therapy. All lesions that showed linear signals in the center or at the periphery of the tumors proved to be recurring tumors (n = 20). In lesions with spotty signals, tumor recurrence was not revealed in nine of 60 lesions.
Power Doppler sonography can be used for follow-up studies after transcatheter arterial chemoembolization therapy as a sensitive and cost-effective imaging technique. Although spotty signals were frequently seen, linear signals appeared to be specific for tumor recurrence.

Full text

Page 1

AJR:172,January1999
67
Power
Assessment
After
forHepatocellular
DopplerSonography
Tumor ofRecurrence
ChemoembolizationTherapy
Carcinoma
Seiya
Yasuyuki
Katsuhiko
Hiroaki
Joji Urata
Taiji Nishiharu
Mutsumasa
Sumi1
Yamashita
Mitsuzaki
Yamamoto
Takahashi
OBJECTIVE.
raphyin
chemoembolization
SUBJECTS AND METHODS.
61 years)
withhepatocellular
phy, helicalCT, and intraarterial
arterial
chemoembolization
tertranscatheterarterial
shape were
evaluated.
helicalCT
andintraarterial
standards
RESULTS. A sonographic
sonography.
Flow
tivity,74%)thanin the
the tumor’s center,
of a signal
a specificity
catheter
arterialchemoembolization
teror at the periphery
spotty signals, tumor
CONCLUSION.
arterial
technique.Although
for tumorrecurrence.
Thisstudywas undertaken
recurrent
to determinethe value of power
after
Dopplersonog-
arterial theevaluationofhepatocellularcarcinomastranscatheter
therapy.
Forty-fivepatients
(age
underwent
range,45-81
power
years;
Doppler
mean
sonogra-
transcatheter
to 6 months
itslocation,
as determined
used as the
age,
carcinomas
digital
therapy
chemoembolization
results
digital
prospectively
subtraction
to evaluate
angiography
for tumor
therapy,
compared
subtraction
beforeand after
Three
signal,
recurrence.
Doppler
tumor
af-
and
on
gold
the
Thewerewith
vascularity
which
angiography,
were
(n = 142).
signalwas seen
to be more
93%).
No correlation
found.Power
of 86%
therapy.All
provedto be recurring
was not revealed
Doppler
sonography
chemoembolization
spottysignalswere
in80 of142lesions
to detect
with
in the left
of the color
tumor
sonography
tumor
showed
linear
tumors(n
of 60 lesions.
beusedfor
as a sensitive
seen,linearsignals
powerDoppler
(sensi-
was
and the
signalin lesions
right
tended
(sensitivity,
or both.
was
difficult
The
lobe
lobelocation
between
signalin
on its periphery,
within
of 85%,
recurrence
had a sensitivity
recurrence
signals
20).
In lesions
location
a tumor
and an accuracy
Doppler
in revealing
lesions
of
87%,
after
in the cen-
trans-
that
of the tumors
recurrence
Power
=
with
in nine
can
follow-up
cost-effective
appeared
studies after
transcatheter
therapy
frequently
and imaging
to be specific
Received March 13,1998;accepted after revision
July 13,1998.
‘All authors: Department of Radiology, Kumamoto
University School of Medicine, 1-1-1 Honjo, Kumamoto
Japan. Address correspondence to V.Yamashita.
860,
AJR1999;172:67-71
0361-803X199/1721-67
© American RoentgenRay Society
T
he treatment effectof transcatheter
arterialchemoembolization
for
hepatocellular
with
contrast-enhanced
angiography,
successfultranscatheter
lization therapy,
on
conventional
hancedCT,which
ofthebloodsupply
sis [2-4].A careful
hepatic
color
Doppler
Doppler sonography
and in detecting
been reported
Recently,
power
carcinomas
has been
conven-
After
evaluated
tional
CT,
[I
chemoembo-
is absent
contrast-en-
the disappearance
tumor
of blood
can be performed
andbiopsy
arterial
enhancement
,
2].
tumor
angiography
indicates
and, therefore,
examination
tumors
and
necro-
flow
using
?vithin
sonography. Thevalue of color
in evaluating
tumor
many
Doppler
the effect
recurrence
of
treatment
has
byinvestigators
sonography
[5-li].
has been
used for evaluating
pler
sonography
slowblood
color Doppler
Inthis
the value
detection
masafter
lization
hepatictumors.Power Dop-
ismore
in tumors
sonography
report,
of power
of recurrent
sensitiveindetecting
flowthan conventional
[12,13].
we
Doppler
prospectively analyzed
in the
carcino-
sonography
hepatocellular
arterial
transcatheter
therapy.
chemoembo-
Subjectsand
Methods
Patients
In
thisprospective study, 72 consecutivepa-
tients
went
also
with
transcatheter
underwent
hepatocellularcarcinoma whounder-
arterialchemoembolization
sonography power Dopplerbe-

Page 2

Sumiet al.
68
AJR:172,January1999
tween October
upexaminations
sonography,
1995 and
that
helical
angiography
Twenty-nine
16 were women
age,
61 years).
these
45
patients,
tected on follow-up
recurrent
or residual
follow-upstudies,
ameter(mean
catheterarterial
performed.
angiography
Dopplersonography.
the liver:41 had
hadalcoholic
December
included
and
were
of the patients
(agerange,
1996.Follow-
Doppler
digital
in 45 pa-
men
years;
lesions
lesions were
Therefore,
foundduring
5 to 98 mm in di-
mm). Before
power
CT,
intraarterial
performed
subtraction
tients.
were
and
45-81mean
Initially,
and
we treated109
in
another
examinations.
lesions
ranging
diameter,
chemoembolization
CT andintraarterial
wereperformed
All
posthepatitic
cirrhosis.
of livercirrhosis,
B, and four
werediagnosed
33de-
142
thewere
from
27.3trans-
therapy
subtraction
1 month
cirrhosis
and four
to the
class A, 14
C. Hepatocellu-
by means
biopsy.
was
digital
within of
ofpatientshad
cirrhosis
AccordingChild
classification
were class
las carcinomas
graphically
transcatheter
tumor
both helical CT and power
27 were
class were
of sono-
Before
therapy,
lesions
sonography.
guided
arterial
percutaneous
chemoembolization
wasshown
Doppler
vascularity
forallon
TranscatheterArterial
andImaging
C.hemoembolizotionTherapy
Techniques
We performed
lization
patic artery
(3-6ml) and a chemotherapeutic
bicin hydrochloride
atm
sponge
particles.
until the tumor
of transcatheter arterial chemoembolization
both
and helicalCF approximately
mont.
If residual vascularity
arterial
chemoembolization
Afterthese
treatments,
pletelydisappeared
enhancement was seen
Completely treated
were monitored
in the same
Power Dopplersonography
performed
in a similar
andaftertreatment.
power Dopplersonography
lical
CT
(onceevery
markers
(once every
subtractionangiography
after transcatheterarterial
apy.Theinterval
sonography andother
to 23 days (average
Power Doppler
sonography
scannerwith
a 3.5-MHz
260A;
Toshiba,Tokyo,
multifrequency
(3.0-,
probe
(Powervision;
a scanner
witha 3.5-MHz
500;
General Electric
kee,
WI).Before follow-up
transcatheter arterial chemoembo-
therapy
by introducinga catheter into thehe-
oiland
injecting a mixtureof an iodized
drug.
either epiru-
followed
particles were
became occluded.
or cisplatinum,
The
vessels
by gel-
injected
The effect
therapy
sonography
after
transcatheter
repeated.
was evaluated on
power
Doppler
3 weeks
wasseen,
treat-
therapywas
tumor enhancement
and slight
remaining
corn-
in 88 lesions,
in the
residual
lesions. 21
andincompletely
fashion.
treated groups
and helical
both
before treatment
studies
(once every
CT were
manner
Follow-upincluded
month),he-
3 months), andserum tumor
3 months).
was performed
chemoembolization
final
examinations
interval,
15 days).
Intraarterialdigital
3-6 months
ther-
between
power
ranged
Doppler
from5
was
performed
probe
on a
convex (SSA-
with a
convex
or on
(LOGIQ
Milwau-
exami-
Japan),
4.2-,
Toshiba,
on a scanner
6.0-MHz)
Tokyo,
convex
Medical Systems,
power
Japan),
probe
Doppler
nations were
Cl’
studies
had performed
low-pulse
tiny vascular
coded
tivity
the beginning
the color
to exceed
conducted,
were
previous
by the radiologists
sonography
frequency
structures.
The
area was restricted
and frame
rate. Color
of eachexamination
gain to the point
the lowestlevel
The power-encoded
as possibleto maximize
and framerate. The
scrutinized,
and the distribution
eachlesion.
quency
was
maintained
tients
(range,
450-1200
repetition
frequency
(450
mize
detection
of
weak
power
Dopplerimages
printer(TCP-7700;Toshiba,
color videoprinter (UP185IMD;
pan). Spectrum
analysis
ble. Because
color gain could be controlled
the variationsin power
the three
units wereassumed
Helical
CT
was performed
S_Advantage; General
the
following
collimation,pitchI or I .2. 120 kVp,
Afterunenhanced
CT
was performed30 sec (arterial
phase), and
180sec
(delayed phase)
ministration of 2 mI/kg of nonionic
(iopamidol,Iopamiron;
mI/sec.All angiograms
an ER-l000
scanner(Shimadzu,
traarterial
digital
subtraction
formed
after
injection of 15-20
mg 1/nil) into the common
a rate of4mI/sec.
sonography and
who reviewed
the examinations.
was used to detect
power
Doppler-en-
to maximize
gain
was
by increasing
at whichthe noise
of color (i.e.,
areawas
the color
colorareas were
of blood
Pulse
repetition
at
1000Hz
Hz).
A low value
Hz) was chosen
signals.Representative
recorded
Tokyo,
Sony,
wasperformed,
all machines performed
in a similar
Doppler
to be negligible.
A
repetition
color
adjusted
sensi-
at
began
thenoise
floor).
much
restricted
sensitivity
carefully
flow was
as
assessedfor
fre-
pa- inmost
of pulse
to opti-
were
on a color
Japan)
Tokyo,
if possi-
or on a
Ja-
similarly
and
fashion,
amongsensitivity
witha system
Medical
(Hi-
Sys-
7-mm
Electric
tems)using
parameters:
and
dynamic
210 mA.
was performed,CT
phase). 70 sec
after
contrast
(portal
bolus ad-
material
Schering, Osaka,
were obtained
Kyoto,
angiography
ml iopamidol
or proper
Japan)
at a
rateof3
using
Japan).
In-
wasper-
(370
hepatic artery
at
Image Evaluation
Before
correlative
before
Doppler
digital
three
study.
and
sonography,
subtraction
radiologists
all images,
after
treatment,
helical
angiography
and
including
obtained
CT, and
were
recurrence
examinations
on power
traarterial
viewed
was determined.
On helical
ated by comparing
ages with
CT attenuation
hancement
unreliable
gion of interest.
angiography,
cularity,
dence
between
werefound,
formed;
appeared
in-
re-
by tumor
CT, tumor enhancement
phase
CT images.
was evalu-
CT im-
We did not use
of tumor
proved
in the re-
digital subtraction
presenceof
or both
If discrepancies
angiographic
examinations
grownor enhancement
follow-up studies,
all threedynamic
unenhanced
values for assessment
becausethis measurement
wheniodized
For intraarterial
weregarded
abnormal
enhancement,
oftumorrecurrence.
helicalCT
follow-up
if lesions had
in the
en-
to be
oil was included
theneovas-
as evi-
andfindings
wereper-
had
thoselesions
were
were
assumed
used
toberecurrences. These
recurrence.
results
as the standards for tumor
The results of power
these
Doppler
standards.
sonography
The
were
correlated
withcriterion for
tumor
was
the
signals
vascularity
the presence
tumor.
were
on powerDopplersonography
ofanabnormal flowpattern in
The patterns
classified
of intratumoral
central.
Doppler
asperipheral.or
both.
Doppler
standards
sonographic
two radiologists.
conference.
Lesions with positive
but no recurrence
regarded
flowsignals onpower
sonography
were
on the gold
asfalse-positives.All
images were
a consensus
Doppler
reviewedseparately by
and
was reached
obtained
in
Powersonograms
before
similar
and
fashion
after treatment
the
were
two
interpreted
radiologists.
in
The
a
bysame
opinionsof theradiologistswhoactually per-
formed
compared
To determine
the sonography
with
examinations
two
werealso
those
the interobserver
of thereviewers.
variability in as-
sessing
kappa
of agreement
values
cate a positive
tive but poor
correlation;
lent correlation.
thedetectionofpower
to measure
two
were
Dopplersignal,
statisticswereusedthe degree
Kappa
to
between
than
theobservers.
considered greaterzero mdi-
correlation: values up to .4,a posi-
a good
correlation:
and
values
greater
of .41-75,
thanvalues .75, an excel-
Results
By
analyzing CTandintraarterial digital
subtraction
(55
in the
were
(47
in
were
was
gold
fordetecting
cates
reviewers.
raphy
was
.84
cates
Two
power
in 80 (56%)
sions,
showed
continuous
sonography
gold
tected
recurrences
sions
curacy,
signals
more
lobe.
Doppler
angiography
right
to be recurrences
in concert.
27
82lesions
lobe)
lobeand in the
and
left
60
proved
lesions
therightlobe
ablated
findings
The
flow signal
correlation
The agreement
operatorand each
and.81,
excellent correlation.
reviewers
Doppler
of
spectral
pulsatile
flow.
and13 in
(i.e.,
were
theleft lobe)
considered
seen);
standards.
onlyiodized
used
agreement
which
between
between
of the two
respectively,which
oil
these
as the
interobserver
was .92, mdi-
two
an excellent
the
the sonog-
reviewers
alsomdi-
agreed by
consensusthat
imaging
142
showedflowsignals
80
lesions.
In 29 ofle-
analysiswas
and
performed:
three
power
compared
vascularity
26
flow,
When
were
tumor
revealed
Doppler
with
was
images
the
de-
standards,
in 71 of 82 lesions
were
(sensitivity,
(Fig.1) and tumor
60excluded
87%:
in5 1 of le-
ac-specificity,
85%;
86%)
in lesions
difficult
InI I lesions
sonography,
(Fig.2 andTable
lobe
those
I ).
Flow
to bein the left
to detect
tended
in the right
with
than
undetectedpower
sevenwerelocatedin

Page 3

.?..
Fig. 1.-81-year-old
A and B, Helical
mass (arrows,
C.Power
womanwithhepatocellular
earlyenhancement
carcinoma aftertranscatheter
arterial
arterialchemoembolization
out in delayed
therapy.
(B). ResidualCT scans
B).
sonogram
show duringphase(A) and washphaseoily contrastmaterial
is presentin peripheryof
Dopplershows linearflowsignalsat centerand at peripheryof tumor(arrowheads).
_i
;orrelatlon
f Power
of theLocation
Doppler
...c Signals
echniques
with
)ther?
Power DopplerSonographyof HepatocellularCarcinoma
AJR:172,
January1999
69
Fig. 2.-il-year-old
nomaafter
therapy.
A, Enhanced
tionof iodized
trast enhancement
angiography
hancement
B,Power
nificant color signal in tumor (arrow).
man withhepatocellular
chemoembolization
carci-
transcatheterarterial
helical
oil within
CT scanshows
but does
denseaccumula-
massnot show
subtraction
contrast
con-
Intraarterial
also did not show
digital
(not shown)
of tumor.
Doppler
en-
sonogramalso doesnot showsig-
?V?i:1?CorreIation of Power DopplerSonographySignalswithOtherTechniques
ColorSignalson
Power
Sonography
Doppler
VascularitySeen on Helical CT and Angiography
PresentAbsent
TotalNo. No.ofLesionsNo.ofLesions
of Lesionsin RightLobe in LeftLobe
TotalNo. No.ofLesionsNo.ofLesions
of Lesionsin Right Lobein Left Lobe
Present
Absent
7151 20
1147
954
51429
Location
on Power
Sonography
of Signals
Doppler
?
Findings
Helical
of Vascularity
CT and Angiography
on
Present ? Absent
Central?.
?
:? ?
Periphe?aI??
:
Both
?
?
24
?
?1:?Lt
?‘
#{149}:32??’?
14??‘?O
theleft
lobe (sensitivity.74%) and tiur
in the
rightlobe (sensitivity.
signals
(32lesions),
or
both
a correlation
93e/?)?
observedFlowwere in the
central
region theperipheral region (37
lesions),
not
regions ( 14lesions).We did
find betweentumorrecur-
rence
(Table
graphic
and
2). In the
locationof intratumoral
80 lesions
flow signals
sono-with residual
signals.20 showedlinear signals
(Figs.
(Fig. 4).
I and3) and60 showedspotty
seen
signals
Tumorvascularity was
withheli-
calCTandintraarterial digitalsubtraction an-
giography
(Table
frequently
for all thelesions
spotty
withlinearsignals
3). Although
signalswere more
seen inrecurrent
seen
In four
tumors.
nine
of these
tumor
60
nine
re-
currence
with
wasnot in oflesions
false-spottysignals.
positivelesions onDopplersonography,
we

Page 4

;orrelation
Power
Signals
Techniques
of theShapeof
Doppler
with
Sonographic
Other
Sumietal.
70
AJR:172,January1999
Fig.
hepatocellular
transcatheter
lization
A, CT image
ment
(arrowheads)
B, Power
linear flow signal at center of tumor
(arrowheads)
in rightlobe,
nor
in left lobe, no significant
signal can be seen.
3-73-year-old
womanwith
aftercarcinoma
arterial chemoembo-
therapy.
shows earlyenhance-
intumors inarterialphase
in rightand left lobes.
sonogramDopplershows
but fortu-
flow
Fig. 4.-67-year-old
nomaafter
therapy.
A, CT image
phasein tumor
ual iodized
B, Power
within tumor (arrowheads)
woman with hepatocellular
transcatheterarterial
carci-
chemoembolization
shows
(arrowhead)
oil is seen within
Doppler
earlyenhancement
in right
mass.
shows
in right lobe.
inarterial
resid-lobe. Spotty
sonogram spottyflow signal
Shape
of Signalson
PowerDoppler
Sori#{243}graphy?
; ?
-
Findings
Helical
of Vascularity
CT and Angiography
on
: ? ?
-?
?
P?resent Absent
Linear
Spotty 1
?
?
?
‘
0
9
performed
not obtained
biopsy;
from
however,
these
tumor cellswere
lesions.
Discussion
Transcatheter
therapy
of treating
arterialchemoembolization
is a widely
usedandeffectivemeans
hepatocellularcarcinoma.Evalua-
tionofthe effectof transcatheterarterial
chemoembolization therapyand earlydetec-
tionofrecurrenceis extremely importantfor
patient
CT
most
survival.CTduring
portography
arteriographyand
the during
sensitive
arterialmay be
techniques for
I 14, 151. but these
andtime-consuming.
detectingsmall
hepatocellular
carcinomas
invasive
procedures
are
Helical
medium
dominant
CTafter rapidinjection of a contrast
facilitates
liverscanningduring the
arterial
in detecting
phase,so ithashigher
sensitivityhypervascular hepato-
cellularcarcinomas than
I 15J.
to detect
conventional
Therefore,
con-
trast-enhancedCT
helical
CT
ity
the
MR
should beusedtumor vascular-
for
detection
the evaluation oftreatmenteffectand
of recurrent lesions.Dynamic
imaging isalso
reported tobe sensitive
for theevaluationofrecurrent hepatocellular
carcinomas
terial
and
material
because of excellent
[ 16, 171. However.
contrast ma-
resolution
MR
bothCT
imagingrequire
the useof contrast
andareexpensive.
Although gray-scalesonographyhas been
used asa noninvasivemeans of detecting he-
patic tumors.this techniquedoesnotprovide
reliableinformation about
the feeding ar-
teryorabout tumorvascularity.Recent ad-
vances inDopplerimaging techniques allow
thevisualization of blood
floW
andthe assess-
ment
The
evaluating
ofhernodynamics
of
treatment
in hepatic
sonography
tun?ors.
value color Dopplerfor
effectsof transcatheter
or percu-
arterial chemoembolizationtherapy
taneous
reported
ethanol
by
injectiontherapy
I 10.
has been
severalauthors
1 1 J. Results
ofpreviousstudieshaveshown thatb??thspec-
tralDoppler andcolor Dopplersonography
can
provideclinically usefulinformationre-
lated
provement
to tumorvascularity.
color
Despite the im-
inDopplersonography.
conventionalcolorDopplersonographyhas
somelimitationssuchasangledependency.
aliasing. and a lackofsensitivityto slowflow.

Page 5

PowerDopplerSonographyof HepatocellularCarcinoma
AJR:172, January
1999
71
Unlike
emphasizes
or both,
colorDoppler sonography,which
velocity. variance
sonography
amplitude
Doppler
information,
power
display
map
Doppler
of
in power
empha-
sizes
the
information.
sonography
of the
Thecolor
displaystheintegrated power
Doppler
signal,
blood
[I 8.
which
cells
l9J.
is related
that
Power
tothe
the
number
Doppler
sonography
ofred
produce
Doppler
shift
can
show
raphy
be
pIer
higher
[201.
gains
Even
thancolorDoppler
slow
on
color
sonog-
intratumoral
detected
than
flowscan
more sensitively
sonography
power Dop-
onDoppler
sonography.
Doppler
Therefore, the
improve
useof
the
power
detec- sonography may
tion
result
recurrence
Power
only
mors
ofintratumoralblood flow, which may
in an improved
detection.
Doppler
sensitivityfor tumor
sonography isusefulnot
in
but also
the differential
in the evaluation
diagnosisofhepatictu-
ofof the efficacy
transcatheterarterialchemoembolization
ther-
apy
viously
study.
andin thedetection of a recurrenceof a pre-
treated hepatocellularcarcinoma.In this
the sensitivityofpowerDoppler sonogra-
phy
the specificity
racy was 86%.
for detecting tumor
85%,
recurrencewas 87%,
was
Although
and
power
the overallaccu-
sonog- Doppler
raphy
results
other
niques
transcatheter
isa noninvasive
correlate
expensive
detecting
technique,
closely
or invasive
tumor
it
those
provides
that
with
from
tech-
after
ther-
vas-
moreimaging
in
vascularity
arterialchemoembolization
apy.
cularity
helical
angiography
viability
Doppler
without
of tumor
crease
imaging.
In thisstudy, we
power
intraarterial
onlycorrelated
Doppler
tumor
sonography,
subtraction
seen
CT,
on
anddigital
(gold
hypovascular
standards).Evaluating
with
difficult.
regarded
maypotentially
the
oflesions
be
were
power
Lesions
as free
imaging
would
signalsDoppler
recurrence,whichin-
false-negative
However,
results
these hypovascular
of power
Doppler
hepato-
cellular
and
certain
carcinomas
not
period
study.
are
a significant
usually less
problem
aggressive
may cause
[211.
for
a
In thiswe foundtwotypes of flow
signalin treatedtumors:linearandspotty.
Linear
tumor
signals
vessels
may
or newly
linear
(tumor
Evaluation
hard-copy
evaluation
appropriate
between
the sonography
representrecanalization of
developed
were
recurrence)
of small
films
real-time
technique.
theradiologist
and
tumoryes-
hy-
sels.
pervascularity
for all lesions.
nals with
difficult;
the most
agreement
formed
When
signals detected,
was
spotty
was
images
However,
shown
sig-
thesomewhat
of
was
the
per-who
thosejustevaluat-
ing
.8 1). When
vascularity
theimages wasexcellent
signals
seenin only
(ic
=
.84,
i?
=
spotty
was
were seen,tumor
the 85%of Ic-
sions.Therefore,
thisfindingis nota reliable
sign
nation
for tumor
may
recurrence,
be needed.
and furtherexami-
Unfortunately,power
Doppler sonography
power
sensitivity
able to use
or unwilling
duringscanning.
scan lesions
lefthepatic
has
pIer
to tissue
patients
major
sonography
motion,
who
hold
addition,
subphrenic
causeof motion
tion.By
threshold,
limitations. Because
increased
were
unable
breath
not
ofthe
Dop-
has
we
an
notit in
to liewere
their
could
area
stillor
In
we
inthe
be- lobe
artifact
a
could
from cardiac pulsa-
display
eliminate
motion
using
we
higherDoppler
effectively
low-velocity
tifact;
Dopplersignal
from ar-
however,
flow
Doppler
signals fromlow-
velocity
could
of the vasculature
inthe lesion
alsobesuppressed.
Power
Doppler
for evaluating
sonography
isasuitable
technique
lar carcinomas
arehypervascular.
is primarily
recurrent
most
advantage
with
hepatocellu-
because
The
associated
recurrenttumors
studyof this
its sensitivity,low
cost,
vasive
CT
patients.
sonography
for follow-up
terial
and easeof use. Moreexpensive andin-
procedures
such
could
as contrast-enhanced
be avoided
use power
imaging
aftertranscatheter
therapy.
or angiography
in most
Doppler
technique
We
currently
as the
of patients
primary
ar-
chemoembolization Linear
sig-
nals
strongly
inthe
suggest
centerorperiphery
recurrence.
of atumor
tumor
If spotty
signals
performed
method
are detected,
for confirmation.
medical
dynamicCT should be
Theimpact
be evaluated
of this
on
costsshould
in the future.
References
1. Seki
guided
hepatocellular
1989:84:1400-1407
2. Joseph
Hepatocellular
percutaneous
1. Nonaka
percutaneous
1. KubotaY, et al. Ultrasonically-
injection
AmJ
ethanoltherapyfor
carcinoma.
Gasirnentem!
FB,Baumgarten
carcinoma:
ethanol
DA,
CT
Bernardino
appearance
therapy.
ME.
after
ablation
Radio!og?’
1993:186:553-556
Bartolozzi
Hepatocellular
aftertranscatheter
3.C, Lencioni
carcinoma:
arterial
injection.
R,Caramella
CT
embolization
Radiolog%
D,etal.
and MRfeatures
and
1994:191:
per-
cutaneous
123-128
Bartolozzi
S. Ciancia
noma
ation
1994:162:827-831
ethanol
4.C,
EM.
percutaneous
contrast-enhanced
Lencioni
Treatment
R, Caramella
of hepatocellular
ethanol
MR
D, Mazzeo
carci-
evalu-
AiR
with
with
injection:
imaging.
5. Tanaka
Okuda
moN.
6.
Tanaka
tocellular
atous
imaging. Radiology
7. Shimamoto
tocellular
pIerUS
149- 153
8.GolliM,
nodular
Doppler
S. KitamuraT, Fujita
flow
M. Nakanishi
of liver
K.
tu-S. Color
AiR
S. Kitamura
carcinoma:
hyperplastic
Doppler imaging
1990:154:509-514
T, Fujita
differentiation
nodule
1992;l82:
5, lshigaki
M. et al. Small hepa-
from
Doppler
adenom-
with color
l6l-l65
flow
K. Sakuma1, et al. Hepa-
carcinoma:
and
evaluationwithcolor
1992:182:
Dop-
MRimaging.
Radiologs
Mathieu
hyperplasia
US in association
D. Anglade
of
MC,et al.Focal
color
Ra-
theliver:
with
value
imaging.
of
MR
dio!og?’1993:187:113-117
NumataK. Tanaka
5, Yonezawa
mors at color
arteriographic
Tanaka K, Inoue
pier sonography
foreandafter
emb()lization.
I I . Lencioni R, Caramella
cellular carcinoma:
evaluate response
9.K. Mitsui K. MoninotoM. lnoue
H. Flow
Doppler
findings.
characteristics
sonography:
of hepatic
correlation
tu-
with
AiR
1993:160:515-521
K, et al. Color10. 5, Numata
of hepatocellular
treatment
AiR
1992:158:541-546
Dop-
carcinoma be-
bytranscatheterarterial
D, Bartolozzi
of color
C. Hepato-
US use Doppler
percutaneous
to
to treatmentwith
ethanol injection.Radiolog?
ChoiBI,Kim
conventional
isoninthedepiction
mors. Radiology
Ohishi H, Hirai
ationof power
nosisof hepatocellular
1996:56:399-404
Matsui0, Takashima
1995:194:1 13-I 18
Ct al.Power
.sonography:
vasculature
1996:200:55-58
T, YamadaR, et al. Clinical
Doppler sonography
carcinoma.
12. TK,Han
Doppler
JK, versus
compar-
liver
color
of intu-
I3. evalu-
diag-
Radio!
for
Ada
the
14.T, KadoyaM,etal. Dy-
namic computedtomographyduringarterial per-
tography:
small
Toinogr
Ueda
of hypervascular
ingspiral
MR imaging.
Yamashita
namic
catheter
of treatment
Bartologgi
tocellular
transcatheter
ethanol
Dymling
mentofblood
trasound.
Jam SP,
the mostsensitive
carcinomas.
examination
J (‘ompi?t
for
hepatocellular
1985:9:19-24
K. Kitagawa
Assist
15. K. Kadoya
hepatocellular
CT:
M. et al. Detection
carcinoma
comparison
1995:20:547-553
S. Sumi M,
of hepatoma
embolizationtherapy:
effect.
ActaRadio!
C, LencioniR, Caramella
carcinoma: CFand
arterialembolization
injection.
Radio!ogv
SO, PerssonHW.
perfusion in tissue
by us-
and volumetricof US
AbdomImaging
16. Y. Yoshimatsu
imaging
arterial
etal.Dy-
MRtreatedby tracts-
assessment
1993:34:303-308
D, et al. Hepa-
MR
features
and percutaneous
1994:191:123-128
HertzCH.
using
1991:17:433-4-44
EF.et al.Influence
17.
after
18. Measure-
Dopplerul-
U!trasoundMed
FanPH,
Rio!
19.Philpotof
variousinstrument settingsontheflowinforma-
Ultrasound
tion
Med
Rubin
Doppler
derived
Biol
from thepower mode.
1991; 17:49-54
Bude
US:a potentially
frequency-based
1994:190:853-856
0.Kadoya
malignant
basedon blood
493-497
20.JM,RO,Carson PL.etal.Power
useful
Doppler
alternative
sonography.
to
mean
color
Radiology
21. Matsui
and
M,Kameyama
in cirrhotic
supply.
T. et al. Benign
livers:
1991:178:
nodulesdistinc-
tion
Radiology