Arts and Sciences 2 Diagnostic significance of contrast-enhanced ultrasonography for hepatocellular adenoma: experiences of two cases 41080 Key words: Abdominal ultrasonography Contrast-enhanced ultrasonography Hepatocellular adenoma Abstract We experienced two cases of hepatocellular adenoma in which contrast-enhanced ultrasonography (US) findings were helpful for diagnosis. In these cases, the absence of findings that indicated intratumoral bleeding of necrosis on computed tomography (CT) made the differential diagnosis between focal nodular hyperplasia and hepatocellular adenoma difficult, although hepatocellular carcinoma was unlikely based on the lack of the defect of the nodular defect on hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance imaging (MRI). In addition, no information was obtained from B-mode US to diagnose hepatocellular adenoma. In contrast, contrast-enhanced US examination provides the findings that were characteristic for hepatocellular adenoma; i.e., droop-formed minute blood vessel construction in its arterial phase. 2 CT MRI wash out MRI 2 1 1 2 3 Contrast- Enhanced Ultrasonography CEUS CT MRI Focal Nodular Hyperplasia Kenichi Takahashi 41080 Department of Clinical Research, Ogaki Municipal Hospital, Gifu, Japan Radiological Technologists FNH CT MRI CEUS CEUS 4 2 2 TOSHIBA Aplio XG MRI PHLIPS Achieva 1.5T Nova CT TOSHIBA Aquilion16 1/2 0.015ml/kg 5.0MHz Differention CHI MI 0.18~0.22 10~15fps 12 212 2015. vol.62 no.749
focus point 1 focus 30 30 120 10 Replenishment Micro Flow Imaging MFI Table 1 Table 1 Laboratory data on admission 04 3 1 37 2007 11 S6 37mm MRI T1 low intensity T2 high intensity CT hypervascular 2007 12 MRI SPIO T1low intensity Heavy T2 high intensity SPIO-T1 SPIO-T2high intensity Long TEhigh intensity Fig. 1 Fig. 1 Magnetic resonance imaging of the liver a T1-emphasized image b Heavy T2-emphasized image c SPIO-contrast enhanced MRI T1-emphasized image d SPIO-contrast enhanced MRI T2-emphasized image e Long TE-emphasized image 13 213
CT CT low density CT iso density Fig. 2 MRI EOB low intensity iso intensity high intensity Fig. 3 CT MRI S6 iso echoic Fig. 4 Fig. 5 CEUS hyper echoic Fig. Fig. 2 Computed tomography of the liver a pre-enhancement b arterial phase of enhancement c portal phase of enhancement d equilibrium phase of enhancement Fig. 3 Contrast-enhanced magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) a pre-enhancement b early phase c late phase d hepatobiliary phase 20 minutes after injection Fig. 4 Abdominal B-mode ultrasonography a right-subcostal view b right-intercostal view 14 214 2015. vol.62 no.749
原 著 学 診断に造影超音波検査が有用であった肝細胞線腫の2症例 術 Arts and Sciences 6 a f 矢印 TOSHIBA の装置に搭載されてい 7 矢印 CEUS 上も 腫瘍内に出血や壊死は認 る Replenishment 法や MFI 法では微細な血管構築 めなかった 経皮針生検の組織所見 がよく分かった Fig. 6 g l 矢印 後血管相は周囲肝と iso echoic であった Fig. ほぼ正常な肝細胞様の細胞が充実性に増殖し 銀 Fig. 5 Doppler ultrasonography examination 04 Pulsative flow toward the tumor was observed by the FFT fast Fourier transform, The figure lower berth analysis. Fig. 6 Contrast-enhanced ultrasonography examination Vascular phase a f arterial phase g l after replenishment Fig. 7 Contrast-enhanced ultrasonography examination Post Vascular phase 学 術 15 215
Fig. 8 2 26 2010 5 S4 31 27 Table 2 CT CT low density CT high density iso density Fig. 9 Table 2 Laboratory data on admission Fig. 8 Pathological findings (obtained by percutaneous needle biopsy) a 40 b 200 Fig. 9 Computed tomography of the liver a pre-enhancement b early phase of enhancement c delate phase of enhancement d equilibrium phase of enhancement Fig. 10 Contrast-enhanced magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) a pre-enhancement b early phase c late phase d hepatobiliary phase 20 minutes after injection 16 216 2015. vol.62 no.749
2 Arts and Sciences MRI EOB low intensity high intensity high intensity Fig. 10 CT MRI S4 hyper echoic Fig. 11 Fig. 12 CEUS hyper echoic Fig. 13 a g Replenishment MFI 04 Fig. 11 Abdominal B-mode ultrasonography right-intercostal view Fig. 12 Doppler ultrasonography examination Pulsative fl ow toward the tumor was observed by the FFT fast Fourier transform, The fi gure lower berth analysis. Fig. 13 Contrast-enhanced ultrasonography examination Vascular phase a g arterial phase h m after replenishment 17 217
Fig. 14 Contrast-enhanced ultrasonography examination Post Vascular phase Fig. 15 Pathological findings obtained by percutaneous needle biopsy a Hematoxylin-Eosin stain 微細な血管構築がよく分かった Fig. 13 h m 矢印 b AZAN stain iso density から low density を呈することが多く 造 影 CT は動脈相で比較的強い造影効果を認め この造 後血管相は周囲肝と iso echoic であった Fig. 影効果は肝細胞癌に比べ遷延し 門脈相および平衡相 14 矢印 CEUS 上も腫瘍内に出血や壊死は認め においては iso density から low density を呈する 5 なかった 経皮針生検の組織所見 HE 染色では肝細胞索の構造は保たれており 明 肝細胞腺腫の MRI 所見として 造影 MRI は基本的 に動脈相において強く造影され 門脈相 後期相では 葉内に入り込む像を認め 周囲の風船化編成を示す iso intensity から low intensity を呈する MRI Gd-EOB-DTPA での肝細胞造影相で 肝 細胞腺腫はほとんどが low intensity FNH は iso intensity から high intensity を呈する 5 といわれ 肝細胞を認め 肝細胞腺腫で矛盾しない所見であっ ている 2 6 らかな細胞異形は認めず Fig. 15 a AZAN 染 色では青色の繊維性結合織が肝細胞索に沿って小 た Fig. 15 b 肝細胞腺腫の画像診断は 一般的に多血性の肝細胞 癌や FNH との鑑別が難しいとされている 今回経験した 2 症例は 肝細胞腺腫を診断する上で 4 考 察 重要所見となる腫瘍内出血や壊死が認められず CT 肝細胞腺腫はまれな良性腫瘍である および MRI 検査では肝細胞癌や FNH と鑑別が疑われ 肝細胞腺腫の CT 所見として 単純 CT は均一でほぼ たが 当院 CT MRI の所見では wash out がないこ 18 218 日本診療放射線技師会誌 2015. vol.62 no.749
2 Arts and Sciences Gd-EOB-MRI low intensity FNH B-mode pseudocapsule FNH 1 2 CEUS CT MRI vasculality 2 CEUS CT MRI CEUS CT MRI FNH CEUS CT MRI CEUS FNH spoke-wheel pattern 3 2 CEUS CEUS 2 CEUS FNH 5 CEUS FNH 2 Table 1 Table 2 Fig.1 1 MRI a. T1 b. Heavy T2 c. SPIO MRI T1 d. SPIO MRI T2 e. Long TE Fig.2 CT a. b. c. d. Fig.3 MRI Gd-EOB-DTPA a. b. c. d. 20 Fig.4 US B-mode a. b. Fig.5 FFT fast Fourier transform. Fig.6 CEUS Vascular phase a f. g l. Replenishment Fig.7 CEUS Post Vascular phase Fig.8 a. 40 b. 200 Fig.9 CT a. b. c. d. Fig.10 MRI Gd-EOB-DTPA a. b. c. d. 20 Fig.11 US B-mode Fig.12 FFT fast Fourier transform. Fig.13 CEUS Vascular phase a g. h m. Replenishment Fig.14 CEUS Post Vascular phase Fig.15 a. HE b. AZAN 1, Liver Cancer, 10, 1, 2004. 2,, 49 11 1402-1413, 2004. 3,, 66 4 909-912, 2005. 4 5, 2 Ⅱ 154-158,,, 2010. 6,, 26 1 100-104,, 2010. 04 19 219