Yoshikazu Hiroi

Clinical efficacy of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC).

PurposeTo evaluate the role of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC).MethodsCEUS and angiography were performed in ten cases of ruptured HCC. We evaluated whether this technique allowed us to determine the bleeding point by observing an extravasation of contrast media into the ascites.ResultsIn four of the ten cases, CEUS demonstrated an extravasation of Levovist into ascites. Angiography showed an extravasation of contrast medium in three of these four cases. In three of the remaining six cases, in which CEUS did not show the presence of contrast medium in ascites, angiography demonstrated an extravasation. In eight cases, it yielded cessation of bleeding. In two cases, embolization was not successful. The bleeding point was not determined by CEUS or angiography in one case.ConclusionCEUS allows us to differentiate active bleeding (presence of contrast medium in the ascites) from nonactive bleeding.

Evaluation of malignancy of hepatocellular carcinoma using the ultrasonic B-mode method: clinical significance of extracapsular invasion of hepatocellular carcinoma using ultrasonography.

PurposeTo determine the influence of capsule formation or presence of capsular invasion on the prognosis of hepatocellular carcinoma (HCC) patients.MethodsThe patient group consisted of 70 patients with 74 HCC lesions who had been examined by US and undergone surgical tumor resection at our institution. For these patients, we conducted the following comparative studies: (a) comparison between halo findings on US and microscopic capsular results; (b) comparison between halo findings on US and tumor diameter, tumor histological differentiation, and serum value of each tumor marker; and (c) comparison between halo findings on US and tumor recurrence.Results(a) The corresponding value between sonographic halo and histological capsule was 90.1%, and that between presence of extracapsular invasion on US and that seen by histology was 88.0%. (b) There was no relation between US images and histological differentiation of tumors. (c) Presence of extracapsular invasion on US was a predisposing factor for the development of tumor recurrence.Conclusion(1) Globally speaking, sonographic halo corresponded to the histological tumor capsule. (2) In patients with extracapsular invasion, tumor recurrence after treatment increased. Thus, a better understanding of sonographic halo findings helps determine diagnostic and therapeutic strategies in HCC patients.

The thread and streaks sign

A 72-year-old man with hepatitis C virus-related liver cirrhosis was admitted to our hospital for intra-arterial chemotherapy for recurrent hepatocellular carcinoma after undergoing radiofrequency ablation and transarterial embolization. The patient had undergone valve replacement for mitral regurgitation at the age of 66. Physical examination revealed no abnormalities. The patient was classifi ed as Child–Pugh B. Abdominal ultrasonography (US) (LOGIQ 7, GE Healthcare, Milwaukee, WI, USA) showed a 35-mm hypoechoic mass in segment 8 and a 40mm hypoechoic mass in segment 3, with a heterogeneous echo pattern of the liver. An isoechoic solid lesion was seen in the umbilical portion of the left portal vein and left medial portal vein (Fig. 1). Although color Doppler US demonstrated only spotty signals in this lesion, B-fl ow with cine capture showed fi ne parallel vessels (Fig. 2a,b). Abdominal angiography revealed the thread and streaks sign in the left lobe of the liver (Fig. 3).