Heterogeneity of microbubble accumulation: a novel approach to discriminate between well-differentiated hepatocellular carcinomas and regenerative nodules.

Abstract	This prospective study aimed to elucidate the possibility of differentiating well-differentiated hepatocellular carcinoma (wHCC) from regenerative nodule (RN) on the basis of the heterogeneity of microbubble accumulation. Intensity analysis was conducted on early-phase and late-phase (60 s and 900 s post-injection; perflubutane microbubble) harmonic sonograms in 33 focal hepatic lesions (≤ 15 mm; 30 patients with chronic liver disease) that were histologically proven as wHCC or RN. Heterogeneity of enhancement, an average of standard deviation of late-phase enhancement in three different sections in the lesions with late-phase iso-enhancement, was examined with respect to the histologic findings. Heterogeneity of enhancement was higher in wHCC (28.7 ± 3.8) than RN (19.8 ± 2.1, p = 0.0213) in the 29 late-phase iso-enhancement lesions. The best cut-off value of the heterogeneity for the diagnosis of wHCC was 25.58, and the sensitivity and specificity were 77.8% and 100%, respectively. A novel parameter, heterogeneity of microbubble accumulation, facilitates differentiation between wHCC and RN showing a late-phase, iso-enhancement appearance.
Authors	Hitoshi Maruyama, Masanori Takahashi, Tadashi Sekimoto, Hidehiro Kamesaki, Taro Shimada, Fumihiko Kanai, Osamu Yokosuka
Journal	Ultrasound in medicine & biology (Ultrasound Med Biol) Vol. 38 Issue 3 Pg. 383-8 (Mar 2012) ISSN: 1879-291X [Electronic] England
PMID	22261511 (Publication Type: Journal Article)
Copyright	Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
Chemical References	Contrast Media Ferric Compounds Oxides Sonazoid Iron
Topics	Adult Aged Aged, 80 and over Carcinoma, Hepatocellular (diagnostic imaging, metabolism, pathology) Cell Differentiation Contrast Media (pharmacokinetics) Diagnosis, Differential Female Ferric Compounds (pharmacokinetics) Humans Iron (pharmacokinetics) Liver Cirrhosis (diagnostic imaging, metabolism, pathology) Liver Neoplasms (diagnostic imaging, metabolism, pathology) Liver Regeneration (physiology) Male Metabolic Clearance Rate Microbubbles Middle Aged Oxides (pharmacokinetics) Reproducibility of Results Sensitivity and Specificity Tissue Distribution Ultrasonography

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