Three-dimensional power Doppler ultrasonography for demonstrating associated arteries of hepatocellular carcinoma

Background and Purpose: Although 2-dimensional (2D) ultrasonography (US) with conventional color and power Doppler US has been applied widely in the differential diagnosis of hepatic tumors and in the follow-up of treatment of hepatocellular carcinomas (HCCs), it has limited capabilities for demonstrating associated arteries of HCCs. Three-dimensional (3D) US can provide more accurate depiction of stereotypic vascular patterns than 2D US. This study investigated the efficacy of 3D power Doppler US versus angiography for demonstrating associated arteries of HCCs. Methods: A total of 24 HCCs with surrounding or intratumoral arteries detected by 2D power Doppler US were studied using a US machine equipped with power Doppler software and a built-in stereo image processing workstation. Serial 2D images were reconstructed into 3D images to analyze the distribution and routes of arteries associated with HCCs. These results were compared with angiographic findings. Results: Three-dimensional US imaging of vasculature associated with HCCs in the 24 patients was categorized into 3 patterns: peripheral arteries around the tumor (pattern I, n = 9); no more than 4 intratumoral arteries with or without originating peripheral arteries (pattern II, n = 9); and prominent (more than 4) intratumoral arteries (pattern III, n = 6). Most feeding arteries shown in angiograms that could be demonstrated by 3D power Doppler US were in HCCs with pattern I and II vasculature. In HCCs with pattern III, the basket vascular pattern shown on angiograms could also be demonstrated on 3D power Doppler US. The vascular proficiency, including major feeding arteries and branches of feeding arteries,could be shown to significantly increase from pattern I to III on 3D power Doppler. but this method had a lower detection rate of smaller branches and neovascularization than angiographic study. Conclusion: Three-dimensional power Doppler US can effectively depict the associated arteries of HCCs, especially the major feeding arteries. Three vascularization patterns of HCCs were categorized in 3D images. There is a good correlation of the findings of 3D power Doppler US with angiographic study. These findings demonstrate the usefulness of 3D power Doppler as a non-invasive alternative to angiographic examination.