[Ultrasound diagnosis of hepatocellular carcinoma]

From 1983 to 1992 we found in 50 patients a hepatocellular carcinoma (HCC). The diagnosis was confirmed by histology (n = 34), cytology (n = 4) or clinical symptoms together with ultrasound findings and laboratory signs. 41 of the tumors occurred in cirrhotic livers. 29 patients had singular tumors, 21 had multiple tumors or diffuse tumor spreading in the whole liver. The singular tumors ranged in size from 1.1 to 15 cm. 8 of these tumors were smaller than 3 cm in diameter. The sonomorphological tumor pattern was hyperechoic in 24 cases, 14 of them had a halo sign. 14 tumors were hypoechoic. In the 12 cases with a mixed sonomorphologic pattern, a mosaic of hyperechoic and hypoechoic areas seemed to be very characteristic. Biopsies of the different parts of such a tumor in 1 patient showed different degrees of fat. By color Doppler-sonography, in 8 of 12 investigated patients an increased tumor perfusion was detected. In conclusion, HCC has different sonomorphologic patterns. The so-called mosaic pattern is characteristic, but rare. A focal lesion in a cirrhotic liver is highly suspicious for HCC. Ultrasound is effective as a screening method for risk groups with liver cirrhosis, hemochromatosis or chronic hepatitis.