宜保 行雄¹, 古田 清¹, 植村 一幸¹, 今井 康晴¹, 清沢 研道¹, 古田 精市¹, 横山 佳代子², 草野 充郎³, 望月 哲仁⁴

Yukio GIBO¹, Kiyoshi FURUTA¹, Kazuyuki UEMURA¹, Yasuharu IMAI¹, Kendo KIYOSAWA¹, Seiichi FURUTA¹, Kayoko YOKOYAMA², Mitsuo KUSANO³, Akihito MOCHIZUKI⁴

¹信州大学第2内科, ²信州大学超音波室, ³長野胃腸病院, ⁴小諸厚生総合病院超音波室

¹2nd Dept. of Internal Medicine Shinshu University School of Medicine, ²Laboratory of US Shinshu University School of Medicine, ³Director of Nagano Icho Hospital, ⁴Laboratory of US Komoro Kosei General Hosoital

キーワード : Hepatocellular Carcinoma, Metastatic Liver Cancer, Diagnostic Ultrasonic Criteria

The ultrasonic criteria for diagnosing mass lesions in the liver was established by the Japanese Society of Ultrasonics in Medicine. We examined these criteria to test their usefullness in histological diagnosis of liver tumor by ultrasonography. Twohundred and sixteen cases of liver tumors (61 HCC, 86 metastatic liver cancer, 66 hemangioma, and 3 metastatic sarcoma) were examined in this study. Small tumors less than 2 cm in diameter were excluded. Hemangioma and metastatic liver cancers were used as controls. We studied the sensitivity, specificity and accuracy of each categories for HCC and metastatic liver cancers. Most reliable sonographic findings of HCC showed sharp and smooth boundaries, mosaic internal echo patterns, posterior echo enhancement, and lateral shadows. In contrast potato or cauliflower shapes, and the presence of a thick marginal hypoechoic zone with blurred internal sides were noticed in cases of metastatic liver cancer. From multivariate analysis, "boundaries" and "posterior echo" is the most useful items in the diagnosis between HCC and Meta. This diagnostic criteria for the pathology of mass lesions in the liver will be more useful to obtain an accurate histological diagnosis if appropriate weights were added to each categories. More exact explanations of the ultrasonic findings based on this criteria will be needed to reduce the rate of misdiagnosis.