Analysis of biological malignancy in early stage HCC using low MI contrast ultrasound and angiogenesis factors.

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PUROPOSE: We have performed visualization of hepatic microcirculation using a new modality of contrast ultrasound, Micro Flow Imaging (MFI) composed of a flash replenishment and maximum intensity holding sequences.MTHODS and MATERIALS: Flash replenishment imaging is an imaging mode which visualizes a re-perfusion of microbubbles with a harmonic ultrasound of a low mechanical index (MI) after destruction of microbubbles with a short time high MI ultrasound exposure. We combined the replenishment imaging with a maximum intensity holding sequence and it is called as MFI, in which the maximum signal reaching at an imaging pixel is hold and images are overlayed. We applied this technique to visualization of neovascularized microcirculation of hepatocellular carcinoma (HCC). The contrast agents used were SonoVue. The subjects were 54 patients with HCCs. The tumor size was ranged from 1 to 5cm and the average was 2.5cm.RESULTS: Hepatic vasculature was opacified with contrast media continuousl … More y until the terminal branches of the neovascularized tumor vessels. The minimum size was 200 μm or less. Tumor vessels of HCC were 1) irregularity in the caliber, 2) tortuosity of traveling and 3) heterogeneity of vascular distribution. These findings were categorized into three patterns. One is "cotton pattern", second "vascular pattern" and the third is "dead branch patter". Pathological findings were compared to these MFI patterns. The "cotton pattern" was often seen in well differentiated HCC, the "vascular pattern" in moderately differentiated HCC and the "dead branch patter" in poorly differentiated HCC. Manifestation of MFI was explained by biological features of neovascularization and vascular invasion according to the histological differentiation.CONCLUSIONS: It has been successfully performed to visualize tumor microcirculation using the MFI sequence, which has not been observed using conventional imaging modalities. Neovascularized tumor vessels were characteristically recognized and it is suggested that this technique will contribute greatly to clinical diagnosis of biological malignant features of HCCs. Less