The efferent blood flow of early hepatocellular carcinoma and borderline lesions: Demonstration by color Doppler imaging

Abstract

We performed waveform analysis of the efferent signal detected within early hepatocellular carcinomas and borderline lesions, in which portal flow was demonstrated. Continuity of this flow with the surrounding vessels was also analyzed. Nine nodules in 7 patients with early hepatocellular carcinomas and borderline lesions were included in this study. Tumor diameter ranged from 1.2 to 3.5 cm; average, 2.1 cm. Waveform of the efferent flow signal from within these nodules was continuous in 5 nodules and biphasic venous in 4 nodules. Outside the nodules, the waveform of the efferent flow signal was that of a biphasic venous wave. All efferent signals were confirmed to continue in the hepatic vein. These findings thus suggest that the draining vessel in early hepatocellular carcinomas and their borderline lesions is the hepatic vein.

Current role of ultrasound in the diagnosis of hepatocellular carcinoma

“…In most HCCs smaller than 2 cm, blood flow is low and appears as lines or dots inside or around the tumor. Typical color Doppler features of a small HCC include afferent continuous waveform signals, which reflect a feeding portal flow [19]. When the diameter of a tumor is 2 cm or more, the blood flow volume increases.…”

Contrast-Enhanced Ultrasonography (CEUS) of Liver Masses — Principles, Clinical Applications, Drawbacks

“…The advanced form of HCC may have the following characteristics: demarcation by a halo and lateral shadow (produced by the fibrous capsule of the tumor); inhomogeneous structure (generated by fibrotic and vascular bands which alternate with areas of intact and necrotic tumoral tissue); irregular, ill defined margins (suggesting an invasion of the surrounding liver parenchyma and of the portal vascular bed); posterior acoustic shadowing (generated by the softer consistency of the tumor compared with the normal liver parenchyma). The distinctive vascular aspect, obtained by using the color coded technique of the blood flow (CFM), is that of a basket pattern, characterized by the presence of arterial vessels that circumscribe the tumor and feed it from outside [39]. The spectral exploration demonstrates accelerated flow velocities and altered impedance indexes, since the vascular resistance of the circulatory bed is lower in the absence of precapillary sphincters.…”

Afferent and Efferent Vessels of Premalignant and Overt Hepatocellular Carcinoma: Observation by Color Doppler Imaging

“…The color Doppler method is able to readily trace efferent blood flow signals in nodules, and three-dimensional imaging shows that this blood flow is continuous with the hepatic vein in the surrounding liver parenchyma via the tumor boundary. On analysis of blood flow waveforms, constant or phasic venous waves were observed [8].…”

“…The color Doppler method is able to trace efferent blood flow in liver tumors, and has been intensively studied since this technique was introduced in the field of abdominal diseases [3,[7][8][9].…”

“…Traceable efferent blood flow signals by the color Doppler method are signals of intratumoral blood flow from the center of the tumor to the boundary or those that reach the surrounding liver parenchyma via the tumor boundary [7][8][9] (fig. 1).…”