DIFFERENTIAL-DIAGNOSIS OF SMALL HEPATOCELLULAR-CARCINOMA AND ADENOMATOUS HYPERPLASIA WITH POWER DOPPLER SONOGRAPHY

OBJECTIVE, The aim of this study was to compare the ability of power D oppler sonography and color Doppler sonography to differentiate hepato cellular carcinoma (HCC) from adenomatous hyperplasia (AH). SUBJECTS A ND METHODS. In 48 patients with cirrhosis of the liver, color Doppler sonography and power Doppler sonography were performed on 53 hepatic n odules smaller than 20 mm in diameter (32 nodules were HCC; 21 nodules were AH). We evaluated the detectability of the pulsatile and continu ous flows in the nodules at each hepatic segment. RESULTS. Thirty-four percent of nodules produced color signal on color Doppler sonography; 77%, on power Doppler sonography (p < .01). The identification rate o f nodules in the left lateral segment was significantly lower than in other segments. Continuous flow was seen in the nodules of both HCC an d AH. However, only in HCC did we see pulsatile flow, For HCC, pulsati le flow was seen with color Doppler sonography in 25% of the nodules s maller than 10 mm in diameter and in 50% of the nodules between 10 and 20 mm, With power Doppler sonography, pulsatile flow was seen in 67% (p < .05) of the nodules smaller than 10 mm and in 90% (p < .01) of th e nodules between 10 and 20 mm. Sensitivity and negative predictive va lue in the differentiation of HCC from AH were significantly higher wi th power Doppler sonography than with color Doppler sonography (81% ve rsus 41%, respectively, for sensitivity and 78% versus 53%, respective ly, for negative predictive value). Specificity, positive predictive v alue, and efficacy of both color Doppler sonography and power Doppler sonography were 100%, 100%, 60%, respectively. CONCLUSION. On the basi s of our results, power Doppler sonography is more sensitive than colo r Doppler sonography in revealing small HCC and in differentiating HCC from AH under physiologic hemodynamic conditions.