Ultrasonographic diagnosis of hepatocellular carcinoma

  • Seigo Sakaguchi
  • Keiji Tohara
  • Yoshihiko Oka


The liver is the largest soft tissue organ in the body and, acoustically, it consists of roughly homogeneous parenchyma. Its position in the body allows negligible interference caused by gas in the digestive canal. Therefore, the liver is an excellent organ to evaluate by means of ultrasonography, especially for the detection of hepatocellular carcinoma (HCC). Normal hepatic parenchyma is seen as a homogeneous and fine echogenic pattern, and focal disorders in the liver cause focal alteration in acoustic impedance which are easily recognizable as abnormally and irregularly localized hypoechoic, isoechoic, hperechoic, or anechoic areas either alone or in combination.


Hydatid Cyst Focal Nodular Hyperplasia Metastatic Carcinoma Cavernous Hemangioma Portal Vein Tumor Thrombosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Sakaguchi S, Tohara K (1990) Ultrasonic diagnosis of chronic hepatitis (in Japanese). Modern Physician 10: 1176–1182Google Scholar
  2. 2.
    Rettenmaier G (1974) Quantitative criteria of intrahepatic echo patterns correlated with structural alterations. In: Vlieger M, White DN, McCready VR (eds) Ultrasonics in medicine. Excerpta Medica, AmsterdamGoogle Scholar
  3. 3.
    Wells PNT, McCarthy CF, Ross FGM, Read AEA (1969) Comparison of A-scan and compound Bscan ultrasonography in the diagnosis of liver disease. Br J Radiol 42: 818–823PubMedCrossRefGoogle Scholar
  4. 4.
    Watanuki S, Kubota H, Fukushima M, Hirakata M (1967) Diagnosis of the hepatic disease by ultrasonic attenuation. Second Report ( English abstract ). Proceedings of JSUM 11: 109–110Google Scholar
  5. 5.
    Ishii K, Doi T, Kurokawa M, Sakaguchi S, Okumura M (1986) Sizes of liver, spleen and portal vein in normal subjects ( English abstract ). Proceedings of JSUM 48: 689–690Google Scholar
  6. 6.
    Doi T, Sakaguchi S (1986) Measurement of the size of the liver, spleen and portal vein in chronic liver diseases ( English abstract ). Jpn J Med Ultrasonics 13: 335–340Google Scholar
  7. 7.
    Cuinaud C (1954) Distribution de l’artère hépatique dans le foie (in French). Acta anat 22: 49–81CrossRefGoogle Scholar
  8. 8.
    Takayasu K, Moriyama N, Muramatsu Y, Shima Y, Ishikawa T, Goto H, Ushio K, Matsue H, Sasagawa M, Yamada T (1984) Clinicoradiological anatomy of the intrahepatic portal vein branches studied by percutaneous transhepatic portography. Proposal of a new nomenclature for the branching order and third order (subsegmental) branches ( English abstract ). Jap J Gastroent 81: 56–65Google Scholar
  9. 9.
    The Japan Society of Ultrasonics in Medicine (1989) A Public Announcement of the Diagnostic Criteria for Liver Tumors. Jpn J Med Ultrasonics 16: 108–111Google Scholar
  10. 10.
    Kumagaya Y (1979) A histological study of hepatocellular carcinoma—obstruction of the common bile duct by intraductal growth (English abstract). Acta Hep Jap 20: 157–163CrossRefGoogle Scholar
  11. 11.
    Hatono N, Tohara K, Sakaguchi S, Oka Y, Okumura M (1990) The evaluation of marginal hypoechoic zone of hepatic tumors ( English abstract ). Proceedings of JSUM 57: 67–68Google Scholar
  12. 12.
    Inayoshi A (1983) Clinical studies on ultrasonic diagnosis of carcinoma of the liver: Comparative study between ultrasonograms and pathological findings (in Japanese). Nippon Shokaki Gekka 16: 2088–2097Google Scholar
  13. 13.
    Okabe M (1979) Patho morphological studies on hepatocellular carcinoma: A study on a mechanism of capsule formation and septum formation of tumor nodule (English abstract). Acta Hepatol Jpn 20: 144–156CrossRefGoogle Scholar
  14. 14.
    Akimoto S, Saitoh A, Watayoh T, Isobe Y, Takasaki T (1984) Diagnostic capability and limitation of ultrasonography in small hepatocellular carcinoma (in Japanese). Fukubu Gazoushindan 4: 209–216Google Scholar
  15. 15.
    Majima Y, Fujimoto T, Iwai I, Tanaka M, Sakai T, Miura C, Abe M, Tanikawa K (1988) Pathological background of the characteristic “bright loop” pattern in ultrasonography of small hepatocellular carcinoma (HCC) ( English abstract ). Proceedings of JUSM 52: 17–18Google Scholar
  16. 16.
    Makuuchi M, Hasegawa H, Yamasaki S, Bandai Y, Watanabe G, Ito T (1981) The characteristic features of small hepatocellular carcinoma smaller than 5 cm in diameter (in Japanese). Acta Hep Jap 22: 1740Google Scholar
  17. 17.
    Edamitsu O, Kiyomatsu K, Nakashima O, Sugihara S, Kojiro M, Saitsu H, Nakayama T, Majima Y, Tanikawa K (1991) Pathomorphologic study on hepatocellular carcinoma showing hyperechoic pattern ( English abstract ). Acta Hepatol Jpn 33: 618–624CrossRefGoogle Scholar
  18. 18.
    Kiyomatsu K (1989) Pathomorphologic study on hepatocellular carcinoma (HCC)—A study of fatty changes in HCC (English abstract). Acta Hepatol Jpn 30: 974–979CrossRefGoogle Scholar
  19. 19.
    Shinagawa T, Ohto M, Kimura K, Matsutani S, Kimura M, Unosawa T, Ukaji H, Tsunetomi S, Nakano T, Morita M, Saisho H, Tsuchiya Y, Ono T, Okuda K (1981) Real-time ultrasonographic diagnosis of hepatocellular carcinoma: Correlation of echograms and histopathological finding ( English abstract ). Jap J Gastroent 78: 2402–2411Google Scholar
  20. 20.
    Boultbee JE (1979) Grey scale ultrasound appearances in hepatocellular carcinoma. Clin Radiol 30: 547–552PubMedCrossRefGoogle Scholar
  21. 21.
    Mizuno Y, Notsumata K, Furusawa A, Motoo Y, Hirai N, Matsui O, Izumi R, Noda Y, Unoura M, Tanaka N, Kobayashi K, Hattori N, Nakamura Y (1989) A case of multilocular cystic hepatocellular carcinoma without underlying cirrhosis ( English abstract ). Acta Hepatol Jpn 30: 75–81CrossRefGoogle Scholar
  22. 22.
    Liver Cancer Study Group of Japan (1990) Followup study of the primary liver cancer in Japan. 9th report, (in Japanese). Japanese Liver Cancer Study Group, KyotoGoogle Scholar
  23. 23.
    Sugiura N, Kora K, Ohto M, Kunio O, Hirooka N (1983) Treatment of small hepatocellular carcinoma by percutaneous transhepatic ethanol injection under ultrasonographic imaging (in Japanese). Acta Hepatol Jpn 24: 920, 1983Google Scholar
  24. 24.
    Sakaguchi S (1987) Diagnosis of liver cancer (in Japanese). Imag Diag. Medicina 24: 1592–1597Google Scholar
  25. 25.
    Osada Y (1981) Clinicopathological studies of ultrasonogram in small hepatocellular carcinoma (English abstract). Jpn J Gastroent 78: 685–692Google Scholar
  26. 26.
    Hirai T, Ohishi H, Yoshimura K, Honda N, Kitamura I, Ohue S, Nishimine K, Ide K, Suzuki R, Uchida I, Satou N, Uchida H (1989) Ultrasonic detectability of multiple small hepatic nodules ( English abstract ). Rinsho Hosyasen 34: 857–863Google Scholar
  27. 27.
    Kawasaki H, Sakaguchi S, Irisa T, Hirayama C (1978) Value of B-scan ultrasonography in the diagnosis of liver cancer. Am J Gastroent 69: 436–442PubMedGoogle Scholar
  28. 28.
    Imai H, Horiguchi Y, Ohsuki M, Kitano T, Takagawa H, Nakano H, Nakajima S, Itoh M, Miyagawa S (1987) A case of squamous cell carcinoma of the liver ( English abstract ). Jpn J Med Ultrasonics 14: 148–152Google Scholar
  29. 29.
    Ishihara A, Kitagawa N, Tsuji Y, Syundo J, Ito S, Kishi S, Mori H, Shimamura Y, Hasegawa H (1989) A Case of Leiomyosarcoma of the Liver ( English abstract ). Jpn J Med 16: 492–498Google Scholar
  30. 30.
    Kurokawa M, Sakaguchi S, Kamachi T, Morioka E, Okumura M (1988) Ultrasonographic study of abdominal lesions in malignant lymphoma (ML)—especially on ultrasonographic findings of hepatic and splenic tumor-forming ML ( English abstract ). Proceedings of JSUM 52: 521–522Google Scholar
  31. 31.
    Teshima T, Morioka E, Ishibashi H, Ikeda K, Ohtsuka T, Niho Y (1987) A Case of Adult T-cell leukemia/lymphoma with nodular lesions ultrasonographically detected in both liver and spleen ( English abstract ). Jpn J Med Ultrasonics 14: 610–613Google Scholar
  32. 32.
    Tanaka K, Egami K, Nakamura E, Natori K, Nakagoshi T, Naito K, Akashi A, Uto K, Nagata O, Natori H, Kaji M, Nakamura S, Yoshida T, Ohtake S, Matsuda T (1987) A Case of ATL Presenting a huge intrahepatic tumor, abated with etoposide (NK-171) therapy alone ( English abstract ). Rinsyou Ketsueki 28: 392–397Google Scholar
  33. 33.
    Koike G, Morioka E, Ishibashi H, Otsuka T, Niho Y (1989) A target appearance of hepatic invasion in adult T-cell leukemia (ATL) ( English abstract ). Jpn J Med Ultrasonics 16: 76–80Google Scholar
  34. 34.
    Karube T, Yano S, Ijima H, Muchi H, Kamoshita S, Itoh K (1985) Ultrasonogram of the liver and brain in a patient with congenital leukemia ( English abstract ). Jpn J Med Ultrasonics 12: 537–542Google Scholar
  35. 35.
    Ishii K, Kurokawa M, Doi T, Simizu M, Sakaguchi S, Okumura M (1987) Twelve Year Observation of Patients with Liver Disease in Fukuoka University Hospital ( English abstract ). Med Bull Fukuoka Univ 14: 47–55Google Scholar
  36. 36.
    Hamaya K, Hashimoto H, Maeda Y (1975) Metastatic carcinoma in cirrhotic liver: Statistical survey autopsies in Japan. Acta Pathol Jpn 25: 153–159PubMedGoogle Scholar
  37. 37.
    Raymond HW (1979) Fundamentals of abdominal sonography: A teaching approach. Grune & Stratton, New YorkGoogle Scholar
  38. 38.
    Gondoh M, Kasumi F, Yanagisawa A (1987) Correlation between ultrasonographic and histological findings of metastatic liver cancer ( English abstract ). Jpn J Med Ultrasonics 14: 181–188Google Scholar
  39. 39.
    Sandler MA, Petrocelli RD, Marks DS, Lopez R (1980) Ultrasonic features and radionuclide correlation in liver cell adenoma and focal nodular hyperplasia. Radiology 135: 393–397PubMedGoogle Scholar
  40. 40.
    Nakashima T, Ohta G, Okudaira M, Arakawa M (eds) (1984) Hepatic diseases mimicking HCC (in Japanese). Chugai Igakusya, TokyoGoogle Scholar
  41. 41.
    Iwai I, Majima Y, Fujimoto T, Tanaka M, Aoki Y, Hirai K, Abe M, Abe H, Tanikawa K, Sugihara S, Fujiyoshi Y (1986) Lipomatous tumors of the liver: Report of two cases ( English abstract ). Jpn J Med Ultrasonics 13: 473–479Google Scholar
  42. 42.
    Ochsner JL, Halpert B (1958) Cavernous hemangioma of the liver. Surgery 43: 577–582PubMedGoogle Scholar
  43. 43.
    Tohara K, Sakaguchi S, Hirano M, Okumura M (1987) Comparison of ultrasonographic findings between hyperechoic lesions in the liver ( English abstract ). Proceedings of JSUM 51: 273–274Google Scholar
  44. 44.
    Deixonne B, Makuuchi M, Pissas JM (1988) Ultrasonography of the liver. In: Deizonne B, Lopez FM (eds) Operative ultrasonography. Springer-Verlag, BerlinGoogle Scholar
  45. 45.
    Tanaka M, Suto T, Kunikane M, Moriyama Y, Kondoh H, Soejima Y, Sasaki D, Yoshida Y (1988) Angiographic pooling findings in cases with hypoechoic hemangiomas of the liver ( English abstract ). Jpn J Ultrasonics 15: 221–230Google Scholar
  46. 46.
    Takehara Y, Nomura M, Matsukawa S, Yasuda T, Yamashita K, Tanaka I, Matsuzawa K, Kojima M, Ohno Y, Matsuda M (1987) Diagnosis of the ultrasonogram: Focal nodular hyperplasia ( FNH) (in Japanese ). Rinsyou Syoukaki Naika 2: 1325–1330Google Scholar
  47. 47.
    Oda T, Sakaguchi S, Okumura M (1990) A case of focal nodular hyperplasia of the liver: Study on diagnostic imaging ( English abstract ). Fukubu Gazou Shindan 10: 81–87Google Scholar
  48. 48.
    Morita S, Okajima K, Tamio T, Kubokawa M, Matsui A, Nakata E, Nakajima T, Ishiga N (1987) A case of focal nodular hyperplasia of the liver and the review of previously reported 44 cases in Japan (in Japanese). Jpn J Gastroent 84: 302–306Google Scholar
  49. 49.
    Freeman MP, Vick CW, Taylor KJW, Carithers RL, Brewer WH (1986) Regenerating nodules in cirrhosis: Appearance with anatomic correlation. AJR 146: 533–536Google Scholar
  50. 50.
    Ida M, Kitagawa K, Kawamura I, Matsui O, Takashima T, Shinmura K, Kinami Y, Shinozaki K (1984) A case report of regenerative nodule in liver cirrhosis: Ultrasonographically mimicking hepatocellular carcinoma ( English abstract ). Acta Hepatol Jpn 25: 400–404CrossRefGoogle Scholar
  51. 51.
    Lee S, Fujita N, Yano A, Kobayashi G, Chonan A, Mochizuki F (1988) A case of hyperechoic regenerating nodules mimicking hemangioma of the liver ( English abstract ). Jpn J Med Ultrasonics 15: 72–78Google Scholar
  52. 52.
    Oka Y, Sakaguchi S, Tohara K, Hatono N, Ueki T, Okumura M (1991) Ultrasonographic findings of small hepatic tumors (less than 2 cm in diameter) ( English abstract ). Proceedings of JSUM 58: 177–178Google Scholar
  53. 53.
    Nambu S, Ichida T, Kojima T, Aoyama K, Matsui S, Yasuyama T, Konda T, Higuchi K, Inoue K, Sasaki H, Yoshimura H, Kasukawa M (1984) A case study of fascioliasis with special reference to immunoserological tests and diagnostic imagings ( English abstract ). Acta Hepatol Jpn 25: 1489–1497CrossRefGoogle Scholar
  54. 54.
    Yoon S, Nakata K, Kawara A, Saeki S, Oimomi M, Baba S, Tsuji M (1986) Ultrasonic findings in two patients with human fascioliasis ( English abstract ). Jpn J Med Ultrasonics 13: 375–383Google Scholar
  55. 55.
    Gharbi HA, Hassine W, Brauner MW, Dupuch K (1981) Ultrasound examination of the hydatic liver. Radiology 139: 459–463PubMedGoogle Scholar
  56. 56.
    Hadidi A (1982) Sonography of hepatic echinococcal cysts. Gastrointest Radiol 7: 349–354PubMedCrossRefGoogle Scholar
  57. 57.
    Beggs I (1983) The Radiological Appearance of Hydatid Disease of the Liver. Clin Radiol 34: 555–563PubMedCrossRefGoogle Scholar
  58. 58.
    Didier D, Weiler S, Rohmer P, Lassegue A, Deschamps JP, Vuitton D, Miguet JP, Weil F (1985) Hepatic alveolar echinococcosis: Correlative US and CT study. Radiology 154: 179–186Google Scholar
  59. 59.
    Chen M, Dong B, Li J, Wan B, Zhang J, Gan L, Ye X, Xu M (1986) Ultrasonographic appearance of echinococcal hydatid cyst ( English abstract ). Jpn J Med Ultrasonics 13: 42–48Google Scholar
  60. 60.
    Amoh K, Arakawa K (1986) Ultrasonographic evaluation of the hepatic alveolar echinococcosis: Experimental and clinical study ( English abstract ). Jpn J Med Ultrasonics 13: 264–271Google Scholar
  61. 61.
    Wakabayashi Y, Suzuki T, Kanesaka N, Kotake F, Kakizaki D, Ike K, Abe K, Amino S (1986) A case of Wilson’s Disease with nodular lesion in liver ( English abstract ). Rinsyo Housyasen 31: 425–427Google Scholar
  62. 62.
    Ishibashi H, Tsuchiya Y, Dohmen K, Shimamura R, Kondo H, Hirata Y, Kudo J (1991) The ultrasonographic appearance of the liver in two patients with Wilson’s Disease presented as fulminant hepatitis. Jpn J Med Ultrasonics 18: 104–110Google Scholar
  63. 63.
    Ohyama Y, Ishida H, Yagisawa H, Morikawa P, Naganuma S, Ishioka T, Masamune O (1990) Two cases of Wilson’s Disease ( English abstract ). Jpn J Med Ultrasonics 17: 90–95Google Scholar
  64. 64.
    Sakaguchi S (1988) Storage disease of the liver (in Japanese). Kan Tan Sui 17: 67–74Google Scholar
  65. 65.
    Kurioka N, Kanno T, Kim K, Toda S, SO K, Nakajima S, Oka H, Asai H, Kuroki T, Harihara S, Yamamoto S, Monna T (1985) Ultrasonic réévaluation of small hepatocellular carcinoma: On the diagnostic problems and the limits of detectability ( English abstract ). Jpn J Gastroent 82: 247–254Google Scholar
  66. 66.
    Gibo Y, Furuta K, Uemura K, Imai Y, Kiyosawa K, Furuta S, Yokoyama K, Kusano M, Mochizuki A (1990) Examination of the usefullness of ultrasonic diagnostic criteria for hepatocellular carcinoma (HCC) and metastatic liver cancer (Meta) ( English abstract ). Jpn J Med Ultrasonics 17: 160–167Google Scholar
  67. 67.
    Hui Z, Nakamura M, Itou K (1990) Ultrasonographic study on 502 cases of malignant tumor in the Liver ( English abstract ). Jpn J Med Ultrasonics 17: 250–259Google Scholar
  68. 68.
    Okuno T, Yamato M, Hisa N, Fujikura Y, Izutsu M, Kaneda S, Sato M, Imai Y, Nishioka K (1983) Real-time ultrasonographic manifestation of hepatocellular carcinoma and metastatic liver tumor: Tumor in Tumor Appearance and Lobulation ( English abstract ). Gazouigakushi 2: 112–120Google Scholar
  69. 69.
    Ohnishi K, Nomura F (1989) Ultrasonic Doppler studies of hepatocellular carcinoma and comparison with other hepatic focal lesions. Gastroenterology 97: 1489–1497PubMedGoogle Scholar
  70. 70.
    Itoh Y, Kawauchi A, Fukunari N, Naitoh S, Shiga S, Nakayama K, Matsui W, Kamiya K, Koike T, Ishii M, Yoneyama K, Takahashi S, Onuki M, Hatta Y (1990) 2-D Doppler echographical evaluation for the differential diagnosis of liver tumors ( English abstract ). Jpn J Med Ultrasonics 17: 260–266Google Scholar
  71. 71.
    Kuratomi S (1976) A histopathological study of hepatocellular carcinoma: Pathology of advanced hepatocellular carcinoma and intravascular tumor thrombosis in relation to vascular structure and alterations (English abstract). Acta Hepatol Jpn 17: 517–527CrossRefGoogle Scholar
  72. 72.
    Sugiura N, Ohto M, Kimura K, Okuda K, Kondo F, Hirooka N (1986) Diagnosis and clinical features of portal vein tumor thrombosis in hepatocellular carcinoma ( English abstract ). Jpn J Gastroent 83: 2151–2160Google Scholar
  73. 73.
    Oda T, Sakaguchi S, Tohara K, Hirano M, Kamachi T, Okumura M (1989) Ultrasonic findings of metastatic adrenal tumor in primary liver cancer ( English abstract ). Proceedings of JSUM 55: 735–736Google Scholar
  74. 74.
    Tohara K (to be published) Evaluation of the hemodynamics of liver masses by ultrasonic Doppler method: Usefullness in differential diagnosis of tumor (English abstract). Acta Hepatol JpnGoogle Scholar
  75. 75.
    Matsuda Y, Yabuuchi I (1986) Hepatic tumors: US contrast enhancement with C02 microbubbles. Radiology 161: 701–705PubMedGoogle Scholar
  76. 76.
    Kudo M, Tomita S, Tochio H, Kashida H, Hirasa M, Todo A (1991) Hepatic focal nodular hyperplasia: Specific findings at dynamic contrastenhanced US with carbon dioxide microbubbles. Radiology 179: 377–382PubMedGoogle Scholar
  77. 77.
    Mihara S (1990) Evaluation of ultrasonic mass screening for hepatocellular carcinoma (English abstract). Jpn J Med Ultrasonics 17: 639–647Google Scholar

Copyright information

© Springer-Verlag Tokyo 1992

Authors and Affiliations

  • Seigo Sakaguchi
    • 1
  • Keiji Tohara
    • 1
  • Yoshihiko Oka
    • 1
  1. 1.First Department of Internal MedicineSchool of Medicine, Fukuoka UniversityFukuokaJapan

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