Role of Doppler Ultrasound in Diagnosis of Hepatocellular Carcinoma with Histopathological Correlation
1Dr Khokan Saha, Radiologist, Department of Radiology & Imaging, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh;
Insights
Doppler sonography effectively differentiates hepatocellular carcinoma (HCC) from other liver lesions. A resistive index (RI) above 0.6 indicates malignancy, while below 0.6 suggests benignancy, aiding in liver neoplasm diagnosis.
Area of Science:
- Radiology and Imaging
- Oncology
- Medical Diagnostics
Background:
- Hepatocellular carcinoma (HCC) presents a significant global health challenge, being a leading cause of cancer mortality.
- Accurate screening and early diagnosis of HCC in at-risk populations are crucial for improved patient outcomes.
- Ultrasound evaluation of the hepatobiliary system is a key component in HCC screening.
Purpose of the Study:
- To assess the diagnostic accuracy of Doppler sonography in distinguishing HCC from other focal liver lesions.
- To evaluate the utility of color Doppler flow imaging (CDFI) and spectral analysis in characterizing liver neoplasms.
- To establish criteria using resistive index (RI) for differentiating malignant from benign liver lesions.
Main Methods:
- A cross-sectional study involving 70 patients with focal liver lesions identified via ultrasound.
- All patients underwent gray-scale ultrasonography, color Doppler, and Fine Needle Aspiration Cytology (FNAC).
- Analysis included visualization of intra-tumoral and peritumoral arterial flow using CDFI and spectral Doppler to determine the resistive index (RI).
Main Results:
- Arterial flow was detected in 85.1% of malignant tumors versus 30.4% of benign lesions.
- The mean resistive index (RI) was significantly higher in malignant tumors (0.76±0.12 for primary, 0.80±0.12 for metastatic) compared to benign lesions (<0.6) (p<0.001).
- An RI >0.6 was identified as a criterion for malignant tumors, and RI <0.6 for benign lesions, correlating with cytopathological findings.
Conclusions:
- The combination of color Doppler flow imaging and resistive index (RI) significantly enhances the differential diagnosis of liver neoplasms.
- Doppler sonography, particularly with RI analysis, provides valuable information for distinguishing HCC from benign liver lesions.
- This imaging technique offers a non-invasive approach to improve the diagnostic accuracy of liver tumors.
Abstract:
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the leading cause (possibly third) of cancer mortality. In a present scenario, HCC displays a challenging clinical problem worldwide. Good-quality ultra sound with careful evaluation of the hepatobiliary system can be a screening examination for HCC in patients at risk. The aim of the study was to determine the diagnostic accuracy of the Doppler sonography for differentiation of hepatocellular carcinoma (HCC) from other focal liver lesions. It was a cross-sectional survey, conducted in the Department of Radiology& Imaging, Mymensingh Medical College, Mymensingh, Bangladesh from January 2017 to December 2018. A total of 70 patients with space occupying lesions on ultrasound were included in this study while pregnant women were excluded. All patients were examined by gray scale ultrasonography, color Doppler and FNAC. To visualize the blood flow, standard color Doppler sonography was used for each lesion. Within the lesions, pulsed Doppler samples were assessed whenever possible on the basis of pulsatile flow & finally resistive index (RI) of intra-tumoral and peritumoral arterial flow was studied. After evaluating by Doppler sonography (CDFI and Spectral analysis), FNAC was done and the specimen was sent to the Department of Pathology for Cytopathological examination. Cytopathology were assessed for confirmation of positive and negative cases of HCC. The detection rate of arterial flow in malignant tumors was 85.1% and in benign lesions were 30.4%. Doppler spectrum analysis showed that the resistive index in primary malignant tumors were 0.76±0.12 and in metastatic tumors were 0.80±0.12 and below 0.6 in benign lesions. The difference was significant (p<0.001). This difference was related with its Cytopathological report. The arterial flow identified by CDFI within the liver lesion with RI >0.6 can be regarded as a criterion of malignant tumors and RI<0.6 can be regarded as benign lesions. This study concluded that the combination of color Doppler flow imaging and RI are more useful in differential diagnosis of liver neoplasms.
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