- Email: [email protected]
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Ultrasound in Medicine and Biology
urethral cooling. In the four dogs with IA cooling, the NVB flow was preserved. There was a statistical significant difference between the damage produced with and without cooling. (Fischer exact: p ⫽ 0.0002 and 0.0041; inverse odds ratios: 13.64 and 8.75, respectively). Conclusions: CEUS can guide RF ablation of the entire prostate. The use of cold saline infusion provides effective protection of the urethra and NVB. 2180 Diagnostic potential of three-dimensional ultrasound-based virtual cystoscopy: An experimental study using pig bladders Moon MH, Kim SH, Lee YH, Cho JY, Jung SI, Park SH, Son KL, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Korea; Seoul National University Hospital, Korea; Asan Medical CentFer, University of Ulsan College of Medicine, Korea Objectives: To investigate the feasibility of 3D US-based virtual cystoscopy in experimentally designed bladder phantoms. Methods: Ten bladder phantoms with simulated polypoid tumors of different sizes were constructed to provide 3D US-based virtual cystoscopic images. The simulated polypoid tumors were divided by the location into group 1 (anterior and posterior wall) and group 2 (the remaining four walls). Two genitourinary radiologists independently interpreted the virtual cystoscopic images, with consensus for cases with discrepant results. Results: In a consensus reading, 3D US-based virtual cystoscopy detected 44 (91.7%) of 48 polypoid lesions. All lesions (n ⫽ 4) with false negative findings 5 mm or smaller in diameter, and so the detection rate of 3D US-based virtual cystoscopy was 81.8% (18/22) for lesions 5 mm or smaller while 100% (26/26) for lesions larger than 5 mm. Detection rate for group 1 (93.8%) was not significantly different from that for group 2 (90.6%)(p ⬎.05). There were seven false positive lesions and reverberation artifact was the most common source of false positive lesions (n ⫽ 4). Blind areas were present in 19 (31.7%) of 60 virtual cystoscopic images, which were seen only in group 2. Conclusions: 3D US-based virtual cystoscopy may be an attractive and convenient alternative to conventional cystoscopy.
Volume 32, Number 5S, 2006 same. However, the method is more visual and may be useful in surgery treatment planning. 2182 US in identifying of retroperitoneal hematoma Trofimova EY, Boyko AV, Abakumov MM, Smoliar AN, N.V. Sklifosovsky Research Institute of Emergency Medical Aid, Russian Federation Objectives: The aim of the study was to evaluate the potential of US in identifying retroperitoneal hematoma. Methods: The study included 76 patients with severe blunt abdominal trauma and retroperitoneal hematoma. They underwent series of abdominal US (including retroperitoneal space); 48 patients underwent surgery. Results: US patterns suggested two types of retroperitoneal hematoma. In 59 patients US demonstrated hematoma of soaking type characterized by thickened tissues and/or muscle, blurred outlines of the tissues, US pattern of “edema”. Within the first h, retroperitoneal hematoma of soaking type were identified in 41 patients, paravesical hematoma were reported in three patients. On the first d, abnormalities in paracolic and pelvic areas were not identified, and were seen on the second and third d. Observation of the patients with soaking type hematoma showed the changing size or localization of hematoma in 92% of patients. US pattern of soaking type hematoma in 17 patients was associated with heterogeneous structures (blood collections), which were seen from the first day of admission. Conclusions: Thus, US can be helpful for identifying a retroperitoneal hematoma and may be used for monitoring of the retroperitoneal space in trauma patients.
LESION CHARACTERIZATION USING US CONTRAST AGENT 2183
2181 The possibilities of 3D sonography in diagnosis and staging of urinary bladder cancer Mitina LA, Kazakevich VI, Stepanov SO, Rusakov IG, Ulianov UV, Hertzen Moscow Oncological Research Institute, Russian Federation Objectives: Transrectal and transvaginal (for women) sonography is standard part of complex examination in patients with urinary bladder cancer (UBC). The method allows to visualize three layers of urinary bladder wall, paravesical structures and tumor invasion depth. Investigation goal was to reveal the possibilities of sonography with threedimensional reconstruction in estimation of invasion depth in cases with UBC. Methods: Transrectal or transvaginal sonography with three-dimensional reconstruction was performed in 40 patients with UBC. 3D US angiography was used in all cases. We studied tumors quantity, their location and invasion depth. All diagnoses were confirmed morphologically. Results: Overall sensitivity of both methods in disclosure of tumors was 95%. There were difficulties and mistakes if tumor size was less then 0,4 cm. Sensitivity of both methods (standard investigation and 3D sonography) for invasion depth detection was the same: 85% in T1–T2 stage, 94% in T3 stage and 100% in T4 stage. However, threedimensional model is more visual and provides showing any cut of tumor in any time. Conclusions: The possibilities of sonography with three-dimensional reconstruction and standard sonography in patients with UBC are the
Characterization of small HCC 2.0 cm or less using real-time contrast-enhanced ultrasound Xu H-X, Lu M-D, The First Affiliated Hospital, Sun Yat-Sen University, China Objectives: To investigate the diagnostic performance of real-time ultrasound in characterization of small hepatocellular carcinoma 2.0 cm or less. Methods: One hundred and four focal liver lesions 2.0 cm or less in 104 consecutive patients underwent baseline and contrast-enhanced ultrasound. A contrast-specific mode of contrast pulse sequencing and a sulphur hexafluoride-filled microbubble contrast agent were used in contrast-enhanced ultrasound. The enhancement patterns of 49 pathologically or clinically proved hepatocellular carcinoma were observed. The diagnostic performances of baseline and contrast-enhanced ultrasound in evaluating hepatocellular carcinoma were analyzed and compared. Results: On contrast-enhanced ultrasound, 43 (87.8%) of the 49 hepatocellular carcinomas lesions were hypervascular, 5 (10.2%) isovascular and 1 (2.0%) hypovascular during arterial phase when compared with the adjacent liver tissue. Thirty-nine (79.6%) hepatocellular carcinomas exhibited washout from portal to late phase. Contrast-enhanced ultrasound improved the diagnostic performance for small hepatocellular carcinoma in terms of sensitivity, negative predictive value, and overall accuracy. The sensitivity, negative predictive value, and overall accuracy before and after contrast agent administration were 28.6% (14/49) versus 79.6% (39/49) (p ⬍ 0.001), 59.8% (52/87)
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versus 90.7% (39/43) (p ⫽ 0.002) and 63.5% (66/104) versus 86.5% (90/104) (p ⬍ 0.001), respectively. Conclusions: Real-time contrast-enhanced ultrasound significantly improved the diagnostic performance in characterization of small hepatocellular carcinomas 2.0 cm or less.
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Objectives: To describe contribution of contrast-enhanced ultrasound (CEUS) in further characterizing indeterminate hepatic nodules on CT/MR in patients at high-risk for HCC. Methods: Contrast-enhanced ultrasound was performed for 173 hepatic nodules in 139 patients at high-risk for HCC who were referred for further characterization of indeterminate lesions on CT/MR. The lesions were evaluated with low-MI continuous scan on contrast specific mode after repeated -bolus injections (n ⫽ 5) of Definity (BristolMyers Squibb). Nodules were diagnosed as HCC, dysplastic/regenerative nodule (DN/RN), hemangioma, pseudomass, or indeterminate based on familiar enhancement patterns. The diagnoses were verified by pathology or imaging follow-up at least 9 months. Results: Of 173 indeterminate lesions on CT/MR, 158/173 were further characterized as HCC (n ⫽ 96), DN/RN (n ⫽ 42), hemangioma (n ⫽ 17), or pseudomass (n ⫽ 3), allowing entry to proper management or follow-up protocol. 5/42 DN/RNs on contrast-enhanced ultrasound have subsequently been diagnosed as HCC. The remaining 15/173 were indeterminate on contrast-enhanced ultrasound and warranted close multimodality follow-up or biopsy. 7/15 were proved to be HCC and 8/15 were DN/RNs. Conclusions: Contrast-enhanced ultrasound is a valuable addition to CT/MR for imaging the liver at risk for HCC. Continuous real time imaging minimizes problems related to timing on CT/MR scan.
Correlation between enhancement pattern on CEUS and differentiation degree of HCC Jiang Y, Lv K, Xia Y, Peking Union Medical College Hospital, China Objectives: To investigate the relationship between enhancement pattern of contrast-enhanced ultrasound (CEUS) and differentiation degree of hepatocellular carcinoma (HCC). Methods: A total of 102 HCCs were studied with CEUS, 32 of them were confirmed pathologically, and others were confirmed with helical CT or DSA. In the pulse inversion harmonic imaging model, a bolus of 2.4 ml SonoVue was injected intravenously, the lesions were observed up to 5 minutes. Video clips were recorded, and then time-intensity curves were computerized and analyzed in order to correlate characteristic of the enhancement pattern with differentiation degree of HCC. Results: With well differentiated HCC group and moderately-poorly differentiated group, the time to peak enhancement were 59.1 ⫾ 18.9 s and 26.9 ⫾ 9.6 s, respectively, which was significantly different between two groups (p ⬍ .05). 86.7%(13/15) of moderately-poorly differentiated HCCs manifested as quick-in and quick-out during CEUS; 70.6% (12/17) of well differentiated HCC manifested as quick-in and relatively slow-out. Conclusions: The characteristics of contrast-enhanced patterns may be useful to indicate the differentiation degree of HCC.
2185 A comparison study of contrast-enhanced ultrasonography with c-contrast-enhanced computed tomography in enhancement pattern of hepatocellular carcinoma Xiaoyan X, First Affiliated Hosipital, Sun Yat-sen University, China Objectives: To compare contrast-enhanced ultrasound (CEUS) with contrast– enhanced computed tomography (CECT) in enhancement pattern of hepatocellular carcinoma (HCC). Methods: Ninety-two HCC patients with 98 lesions underwent examination of CEUS and CECT. CEUS was performed with SonoVue and contrast pulse sequencing (CPS). CECT was performed with Ultravist and a standard biphasic helical CT scanning procedure. Results: All of the 98 lesions (100%) showed enhancement on CEUS and CECT in arterial phase. The number of the lesions with hyperenhancing on CEUS and CECT was 98 (100%) and 94 (95.9%), respectively (p ⫽ 0.121). Four (4.1%) lesions showed iso-enhancing in arterial phase on CECT. In portal phase, the number of the lesions with hypo-enhancing on CEUS and CECT was 82 (83.7%) and 83(84.7%), respectively (p ⫽ 0.845). Peripheral thin-rim-like enhancement was exhibited in 30 lesions (30.6%) on CEUS and 31 (31.6%) on CECT (p ⫽ 0.877). With regard to intratumoral vessels, the visualization was found in 94 (95.9%) lesions on CEUS and 36 (36.7%) on CECT (p ⫽ 0.000). Conclusions: The enhancement pattern of HCC on CEUS was consistent with that on CECT, whereas CEUS has the advantages of easy performance, real-time scanning and readily available.
Further characterization of indeterminate hepatic nodules on CT/MR in patients at high-risk for hepatocellular carcinoma with contrast-enhanced ultrasound Jang H-J, Kim TK, Burns PN, Wilson SR, University of Toronto, Canada
2187 Value of contrast-enhanced intermediate mechanical-index coded harmonic angio for characterization of hepatic tumors Lee JM, Han JK, Kim SH, Lee JY, Choi BI, Seoul National University Hospital, Korea Objectives: To evaluate the value of contrast-enhanced coded harmonic angio (CHA) imaging at intermediate mechanical index (MI) using accumulation technique in showing the characteristic hemodynamics of hepatic tumors. Methods: Using a microbubble contrast agent (Levovist, 4 g) we performed coded harmonic angio in 73 patients with focal hepatic tumor nodules such as hepatocellular carcinomas, metastases, hemangiomas, focal nodular hyperplasias, and cholangiocarcinomas. After injecting Levovist, we performed real-time scanning and sweep scanning in the vascular phase and postvascular phase, respectively, using coded harmonic angio technique at either high MI (n ⫽ 30) or intermediate MI (n ⫽ 43). For early arterial phase imaging, accumulation technique was used with coded harmonic angio. Results: Contrast-enhanced CHA using accumulation mode at intermediate MI allowed real time evaluation of vascular phase with less blooming artifact compared with high MI technique. In addition, intermediate MI technique showed more homogeneous hepatic parenchymal enhancement in a field of view during postvascular phases than high MI technique (p ⬍ 0.05). On contrast-enhanced coded harmonic angio, the characteristic hemodynamic patterns of focal hepatic tumors were shown in all cases. Conclusions: Contrast-enhanced coded harmonic angio using accumulation mode at intermediate MI is a promising method to provide useful information for the differential diagnosis of hepatic tumors.
Ultrasound in Medicine and Biology
urethral cooling. In the four dogs with IA cooling, the NVB flow was preserved. There was a statistical significant difference between the damage produced with and without cooling. (Fischer exact: p ⫽ 0.0002 and 0.0041; inverse odds ratios: 13.64 and 8.75, respectively). Conclusions: CEUS can guide RF ablation of the entire prostate. The use of cold saline infusion provides effective protection of the urethra and NVB. 2180 Diagnostic potential of three-dimensional ultrasound-based virtual cystoscopy: An experimental study using pig bladders Moon MH, Kim SH, Lee YH, Cho JY, Jung SI, Park SH, Son KL, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Korea; Seoul National University Hospital, Korea; Asan Medical CentFer, University of Ulsan College of Medicine, Korea Objectives: To investigate the feasibility of 3D US-based virtual cystoscopy in experimentally designed bladder phantoms. Methods: Ten bladder phantoms with simulated polypoid tumors of different sizes were constructed to provide 3D US-based virtual cystoscopic images. The simulated polypoid tumors were divided by the location into group 1 (anterior and posterior wall) and group 2 (the remaining four walls). Two genitourinary radiologists independently interpreted the virtual cystoscopic images, with consensus for cases with discrepant results. Results: In a consensus reading, 3D US-based virtual cystoscopy detected 44 (91.7%) of 48 polypoid lesions. All lesions (n ⫽ 4) with false negative findings 5 mm or smaller in diameter, and so the detection rate of 3D US-based virtual cystoscopy was 81.8% (18/22) for lesions 5 mm or smaller while 100% (26/26) for lesions larger than 5 mm. Detection rate for group 1 (93.8%) was not significantly different from that for group 2 (90.6%)(p ⬎.05). There were seven false positive lesions and reverberation artifact was the most common source of false positive lesions (n ⫽ 4). Blind areas were present in 19 (31.7%) of 60 virtual cystoscopic images, which were seen only in group 2. Conclusions: 3D US-based virtual cystoscopy may be an attractive and convenient alternative to conventional cystoscopy.
Volume 32, Number 5S, 2006 same. However, the method is more visual and may be useful in surgery treatment planning. 2182 US in identifying of retroperitoneal hematoma Trofimova EY, Boyko AV, Abakumov MM, Smoliar AN, N.V. Sklifosovsky Research Institute of Emergency Medical Aid, Russian Federation Objectives: The aim of the study was to evaluate the potential of US in identifying retroperitoneal hematoma. Methods: The study included 76 patients with severe blunt abdominal trauma and retroperitoneal hematoma. They underwent series of abdominal US (including retroperitoneal space); 48 patients underwent surgery. Results: US patterns suggested two types of retroperitoneal hematoma. In 59 patients US demonstrated hematoma of soaking type characterized by thickened tissues and/or muscle, blurred outlines of the tissues, US pattern of “edema”. Within the first h, retroperitoneal hematoma of soaking type were identified in 41 patients, paravesical hematoma were reported in three patients. On the first d, abnormalities in paracolic and pelvic areas were not identified, and were seen on the second and third d. Observation of the patients with soaking type hematoma showed the changing size or localization of hematoma in 92% of patients. US pattern of soaking type hematoma in 17 patients was associated with heterogeneous structures (blood collections), which were seen from the first day of admission. Conclusions: Thus, US can be helpful for identifying a retroperitoneal hematoma and may be used for monitoring of the retroperitoneal space in trauma patients.
LESION CHARACTERIZATION USING US CONTRAST AGENT 2183
2181 The possibilities of 3D sonography in diagnosis and staging of urinary bladder cancer Mitina LA, Kazakevich VI, Stepanov SO, Rusakov IG, Ulianov UV, Hertzen Moscow Oncological Research Institute, Russian Federation Objectives: Transrectal and transvaginal (for women) sonography is standard part of complex examination in patients with urinary bladder cancer (UBC). The method allows to visualize three layers of urinary bladder wall, paravesical structures and tumor invasion depth. Investigation goal was to reveal the possibilities of sonography with threedimensional reconstruction in estimation of invasion depth in cases with UBC. Methods: Transrectal or transvaginal sonography with three-dimensional reconstruction was performed in 40 patients with UBC. 3D US angiography was used in all cases. We studied tumors quantity, their location and invasion depth. All diagnoses were confirmed morphologically. Results: Overall sensitivity of both methods in disclosure of tumors was 95%. There were difficulties and mistakes if tumor size was less then 0,4 cm. Sensitivity of both methods (standard investigation and 3D sonography) for invasion depth detection was the same: 85% in T1–T2 stage, 94% in T3 stage and 100% in T4 stage. However, threedimensional model is more visual and provides showing any cut of tumor in any time. Conclusions: The possibilities of sonography with three-dimensional reconstruction and standard sonography in patients with UBC are the
Characterization of small HCC 2.0 cm or less using real-time contrast-enhanced ultrasound Xu H-X, Lu M-D, The First Affiliated Hospital, Sun Yat-Sen University, China Objectives: To investigate the diagnostic performance of real-time ultrasound in characterization of small hepatocellular carcinoma 2.0 cm or less. Methods: One hundred and four focal liver lesions 2.0 cm or less in 104 consecutive patients underwent baseline and contrast-enhanced ultrasound. A contrast-specific mode of contrast pulse sequencing and a sulphur hexafluoride-filled microbubble contrast agent were used in contrast-enhanced ultrasound. The enhancement patterns of 49 pathologically or clinically proved hepatocellular carcinoma were observed. The diagnostic performances of baseline and contrast-enhanced ultrasound in evaluating hepatocellular carcinoma were analyzed and compared. Results: On contrast-enhanced ultrasound, 43 (87.8%) of the 49 hepatocellular carcinomas lesions were hypervascular, 5 (10.2%) isovascular and 1 (2.0%) hypovascular during arterial phase when compared with the adjacent liver tissue. Thirty-nine (79.6%) hepatocellular carcinomas exhibited washout from portal to late phase. Contrast-enhanced ultrasound improved the diagnostic performance for small hepatocellular carcinoma in terms of sensitivity, negative predictive value, and overall accuracy. The sensitivity, negative predictive value, and overall accuracy before and after contrast agent administration were 28.6% (14/49) versus 79.6% (39/49) (p ⬍ 0.001), 59.8% (52/87)
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versus 90.7% (39/43) (p ⫽ 0.002) and 63.5% (66/104) versus 86.5% (90/104) (p ⬍ 0.001), respectively. Conclusions: Real-time contrast-enhanced ultrasound significantly improved the diagnostic performance in characterization of small hepatocellular carcinomas 2.0 cm or less.
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Objectives: To describe contribution of contrast-enhanced ultrasound (CEUS) in further characterizing indeterminate hepatic nodules on CT/MR in patients at high-risk for HCC. Methods: Contrast-enhanced ultrasound was performed for 173 hepatic nodules in 139 patients at high-risk for HCC who were referred for further characterization of indeterminate lesions on CT/MR. The lesions were evaluated with low-MI continuous scan on contrast specific mode after repeated -bolus injections (n ⫽ 5) of Definity (BristolMyers Squibb). Nodules were diagnosed as HCC, dysplastic/regenerative nodule (DN/RN), hemangioma, pseudomass, or indeterminate based on familiar enhancement patterns. The diagnoses were verified by pathology or imaging follow-up at least 9 months. Results: Of 173 indeterminate lesions on CT/MR, 158/173 were further characterized as HCC (n ⫽ 96), DN/RN (n ⫽ 42), hemangioma (n ⫽ 17), or pseudomass (n ⫽ 3), allowing entry to proper management or follow-up protocol. 5/42 DN/RNs on contrast-enhanced ultrasound have subsequently been diagnosed as HCC. The remaining 15/173 were indeterminate on contrast-enhanced ultrasound and warranted close multimodality follow-up or biopsy. 7/15 were proved to be HCC and 8/15 were DN/RNs. Conclusions: Contrast-enhanced ultrasound is a valuable addition to CT/MR for imaging the liver at risk for HCC. Continuous real time imaging minimizes problems related to timing on CT/MR scan.
Correlation between enhancement pattern on CEUS and differentiation degree of HCC Jiang Y, Lv K, Xia Y, Peking Union Medical College Hospital, China Objectives: To investigate the relationship between enhancement pattern of contrast-enhanced ultrasound (CEUS) and differentiation degree of hepatocellular carcinoma (HCC). Methods: A total of 102 HCCs were studied with CEUS, 32 of them were confirmed pathologically, and others were confirmed with helical CT or DSA. In the pulse inversion harmonic imaging model, a bolus of 2.4 ml SonoVue was injected intravenously, the lesions were observed up to 5 minutes. Video clips were recorded, and then time-intensity curves were computerized and analyzed in order to correlate characteristic of the enhancement pattern with differentiation degree of HCC. Results: With well differentiated HCC group and moderately-poorly differentiated group, the time to peak enhancement were 59.1 ⫾ 18.9 s and 26.9 ⫾ 9.6 s, respectively, which was significantly different between two groups (p ⬍ .05). 86.7%(13/15) of moderately-poorly differentiated HCCs manifested as quick-in and quick-out during CEUS; 70.6% (12/17) of well differentiated HCC manifested as quick-in and relatively slow-out. Conclusions: The characteristics of contrast-enhanced patterns may be useful to indicate the differentiation degree of HCC.
2185 A comparison study of contrast-enhanced ultrasonography with c-contrast-enhanced computed tomography in enhancement pattern of hepatocellular carcinoma Xiaoyan X, First Affiliated Hosipital, Sun Yat-sen University, China Objectives: To compare contrast-enhanced ultrasound (CEUS) with contrast– enhanced computed tomography (CECT) in enhancement pattern of hepatocellular carcinoma (HCC). Methods: Ninety-two HCC patients with 98 lesions underwent examination of CEUS and CECT. CEUS was performed with SonoVue and contrast pulse sequencing (CPS). CECT was performed with Ultravist and a standard biphasic helical CT scanning procedure. Results: All of the 98 lesions (100%) showed enhancement on CEUS and CECT in arterial phase. The number of the lesions with hyperenhancing on CEUS and CECT was 98 (100%) and 94 (95.9%), respectively (p ⫽ 0.121). Four (4.1%) lesions showed iso-enhancing in arterial phase on CECT. In portal phase, the number of the lesions with hypo-enhancing on CEUS and CECT was 82 (83.7%) and 83(84.7%), respectively (p ⫽ 0.845). Peripheral thin-rim-like enhancement was exhibited in 30 lesions (30.6%) on CEUS and 31 (31.6%) on CECT (p ⫽ 0.877). With regard to intratumoral vessels, the visualization was found in 94 (95.9%) lesions on CEUS and 36 (36.7%) on CECT (p ⫽ 0.000). Conclusions: The enhancement pattern of HCC on CEUS was consistent with that on CECT, whereas CEUS has the advantages of easy performance, real-time scanning and readily available.
Further characterization of indeterminate hepatic nodules on CT/MR in patients at high-risk for hepatocellular carcinoma with contrast-enhanced ultrasound Jang H-J, Kim TK, Burns PN, Wilson SR, University of Toronto, Canada
2187 Value of contrast-enhanced intermediate mechanical-index coded harmonic angio for characterization of hepatic tumors Lee JM, Han JK, Kim SH, Lee JY, Choi BI, Seoul National University Hospital, Korea Objectives: To evaluate the value of contrast-enhanced coded harmonic angio (CHA) imaging at intermediate mechanical index (MI) using accumulation technique in showing the characteristic hemodynamics of hepatic tumors. Methods: Using a microbubble contrast agent (Levovist, 4 g) we performed coded harmonic angio in 73 patients with focal hepatic tumor nodules such as hepatocellular carcinomas, metastases, hemangiomas, focal nodular hyperplasias, and cholangiocarcinomas. After injecting Levovist, we performed real-time scanning and sweep scanning in the vascular phase and postvascular phase, respectively, using coded harmonic angio technique at either high MI (n ⫽ 30) or intermediate MI (n ⫽ 43). For early arterial phase imaging, accumulation technique was used with coded harmonic angio. Results: Contrast-enhanced CHA using accumulation mode at intermediate MI allowed real time evaluation of vascular phase with less blooming artifact compared with high MI technique. In addition, intermediate MI technique showed more homogeneous hepatic parenchymal enhancement in a field of view during postvascular phases than high MI technique (p ⬍ 0.05). On contrast-enhanced coded harmonic angio, the characteristic hemodynamic patterns of focal hepatic tumors were shown in all cases. Conclusions: Contrast-enhanced coded harmonic angio using accumulation mode at intermediate MI is a promising method to provide useful information for the differential diagnosis of hepatic tumors.