Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: Comparison with Gd-EOB-DTPA-enhanced MRI

Hideko Ohama, Yasuharu Imai, Osamu Nakashima, Sachiyo Kogita, Manabu Takamura, Masatoshi Hori, Yasushi Seki, Yoshiyuki Sawai, Takumi Igura, Kazuto Fukuda, Yuki Makino, Osakuni Morimoto, Masahiko Ohsawa, Michiie Sakamoto, Takamichi Murakami

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20 Citations (Scopus)

Abstract

Background: Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC. Methods: Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively. Results: On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P < 0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P < 0.001). Conclusions: In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.

Original languageEnglish
Pages (from-to)1081-1093
Number of pages13
JournalJournal of gastroenterology
Volume49
Issue number6
DOIs
Publication statusPublished - 2014 Jun

Keywords

  • Gd-EOB-DTPA
  • Hepatobiliary phase
  • Hepatocellular carcinoma
  • Kupffer cell
  • Organic anion transporting polypeptide 8
  • Post-vascular phase
  • Sonazoid

ASJC Scopus subject areas

  • Gastroenterology

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    Ohama, H., Imai, Y., Nakashima, O., Kogita, S., Takamura, M., Hori, M., Seki, Y., Sawai, Y., Igura, T., Fukuda, K., Makino, Y., Morimoto, O., Ohsawa, M., Sakamoto, M., & Murakami, T. (2014). Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: Comparison with Gd-EOB-DTPA-enhanced MRI. Journal of gastroenterology, 49(6), 1081-1093. https://doi.org/10.1007/s00535-013-0859-1