Sonographic characterisation of hepatocellular carcinoma at time of diagnosis

Hepatocellular carcinoma (HCC) is a malignant liver tumour with a high prevalence world-wide. For screening procedures conventional transabdominal B-mode ultrasound and AFP determination are commonly used. We investigated 100 consecutive patients with histologically proven hepatocellular carcinoma in order to evaluate sonographic characteristics in unselected patients and to compare native and contrast-enhanced ultrasonographic techniques.

We investigated 100 consecutive patients with hepatocellular carcinoma at time of diagnosis with respect to echogenicity, patterns of vascularity, and portal/hepatic vein thrombosis. In addition to B-mode and native power Doppler sonography, contrast-enhanced power Doppler sonography with SHU 508A was used in 65 patients.

The ultrasound appearance with conventional B-mode of hepatocellular carcinoma was hypoechoic in 48 % of the cases, isoechoic in 9 %, hyperechoic in 19 %, and in 25 % a mixture between hyper- and hypoechoic appearance was found compared to the surrounding liver tissue. Contrast-enhanced power Doppler sonography with SHU 508A changed the pattern of tumour vascularity in 27 % of patients into hypervascular, mainly in small lesions.

At the time of diagnosis, the most commonly observed finding in hepatocellular carcinoma is that they appear hypervascular, independent of their size. The use of ultrasound contrast media should be considered to achieve characterisation of liver nodules in cirrhotic livers because they can improve the evaluation of tumour vascularity. Hypovascular HCC are found in about 10 % even after the administration of a contrast agent.