伊藤 洋二¹, 川内 章裕¹, 福成 信博¹, 内藤 誠二¹, 志賀 俊行¹, 中山 国明¹, 松井 渉¹, 神谷 憲太郎¹, 小池 正¹, 石井 誠², 米山 啓一郎², 高橋 正一郎², 小貫 誠², 八田 善夫²

Yoji ITOH¹, Akihiro KAWAUCHI¹, Nobuhiro FUKUNARI¹, Seiji NAITOH¹, Toshiyuki SHIGA¹, Kuniaki NAKAYAMA¹, Wataru MATSUI¹, Kentaro KAMIYA¹, Tadashi KOIKE¹, Makoto ISHII², Keiichiro YONEYAMA², Seiichiro TAKAHASHI², Makoto ONUKI², Yoshio HATTA²

¹昭和大学医学部外科, ²昭和大学医学部第二内科

¹Department of Surgery, Showa University School of Medicine, ²Department of 2nd Internal Medicine, Showa University School of Medicine

キーワード : 2-D Doppler echography, Liver tumor, Blood flow in tumor, Blood flow velocity

The clinical application of pulsed Doppler examination for the diagnosis of hepatocellular carcinoma (HCC) has been already reported, but it is not widely used because of the difficulty in detection of the blood flow.
In this study, using a 2-D Doppler echography equipment, SAL-65A (Toshiba Co., Tokyo) with 3.75 MHz and 5.0 MHz probe, the blood flow of the liver tumor was measured quantitatively and its clinical utility was evaluated.
Thirty nine patients with liver tumors including twenty one HCC, nine metastatic liver tumors and nine hemangiomas were examined to detect the blood flow in the tumor by the 2-D combined with pulsed Doppler method.
The 2-D Doppler detection rate of the blood flow in the tumor were 95% in HCCs, 56% in metastatic liver tumors and 44% in hemangiomas.
Doppler signals obtained from the tumors were classified into three types of Doppler spectrums; the high-velocity pulsative waveform (HV), the low-velocity pulsative waveform (LV) and the continuous waveform (CW).
Maximum blood flow velocity (Vmax) in the HV type was ranged from 0.4 to 1.08 m/sec, whereas　Vmax in the LV type was ranged from 0.11 to 0.59 m/sec. All of Vmax in the CW type was less than 0.47 m/sec.
Doppler signals of the HV and CW types were detected mainly in boundary of tumor and Doppler signals of the LV types were detected in the center of tumor.
Vmax was ranged from 0.08 to 1.08 m/sec in twenty HCCs. In addition, Vmax equal to or more than 0.54 m/sec was obtained only in HCCs.
Five metastatic liver tumors out of nine, showed Vmax between 0.08 and 0.51 m/sec and all of nine hemangiomas revealed the low velocity blood flow less than 0.14 m/sec and the CW type of Doppler spectrums.
In conclusion, 2-D Doppler echography combination with Vmax measurement was useful to predict HCC.