Small hepatocellular carcinoma: diagnosis with US angiography with intraarterial CO2 microbubbles.

Abstract

Ultrasonographic (US) angiography enhanced with intraarterial CO2 microbubbles, a contrast material used in US imaging, was performed of 103 histologically proved hepatocellular carcinomas (HCCs) smaller than 3 cm in diameter in 95 patients. The detection rate for hypervascular HCC with US angiography was compared with the rate of detection with conventional angiography, digital subtraction angiography (DSA), and computed tomography (CT) after intraarterial injection of iodized oil. Sensitivity in detection of hypervascular HCCs with US angiography was 86% (89 of 103 HCCs), compared with 63% (44 of 70 HCCs) detected with conventional angiography, 70% (23 of 33 HCCs) with DSA, and 82% (75 of 91 HCCs) with CT with iodized oil. US angiography depicted small hypervascular HCCs, especially those less than 1 cm in diameter, and helped clarify vascularity as isovascular or hypovascular in angiographically undetectable HCCs. Findings at US angiography assisted the choice of a therapeutic strategy for treatment of HCC, such as transarterial therapy, percutaneous ethanol injection therapy, or resection.

Pathologic diagnosis of early hepatocellular carcinoma: A report of the international consensus group for hepatocellular neoplasia

“…Typically, the less-differentiated component is more vascular than the parent component. [23][24][25][26][27] However, if the parent nodule is a dysplastic nodule and the subnodule is well-differentiated HCC, the subnodule may not be hypervascular, because unpaired arteries have not yet developed. Such unpaired arteries are small arteries (unaccompanied by bile duct) occurring outside the original portal tracts, and are indicative of neovascularization.…”

Correlation between Dynamic Computed Tomographic and Histopathological Findings in the Diagnosis of Small Hepatocellular Carcinoma

“…Advances in imaging promote the detection of small HCCs [7, 8, 9, 10, 11, 12, 13]. While advanced HCCs manifest characteristic CT findings, the features of small HCCs often vary [14, 15, 16].…”

Carbon Dioxide in Vascular Imaging and Intervention

“…US angiography is performed by injecting C 0 2 microbubbles through a catheter placed in the hepatic arteries. During the US procedure, C 0 2 microbubbles should be injected slowly, at a rate of approximately 2 ml/s, permitting an accurate evaluation of the C 0 2 flow within the liver and the nodule from the early arterial phase to the late phase (21,22). These investigations proved that US angiography enhanced with intraarterial C 0 2 microbubbles is a highly sensitive tool for detecting small hypervascular hepatocellular carcinomas, especially those smaller than 1 cm in diameter.…”

“…In recent years, the role of US angiography enhanced with intraarterial C 0 2 microbubbles has been confirmed in detecting hepatocellular carcinoma and hepatic focal nodular hyperplasia (18,21,22). C 0 2 microbubbles are prepared by vigorously mixing 10 cc of C02, 10 ml of heparinized normal saline, and 5 ml of the patient's own blood.…”