vol. 37, pp. 239 - marianna uigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37... · fig. 1....

9
臄腲腴腧腶腮腻膆臔膋膨膭 Vol. 37, pp. 239247, 2009 腖腋腚腐腑腃腏腙腞腗腉腃腝腍腌: 腔腊腆腇腅腈 CT 腖腋腚腐腑腄腛腎腕腓腀腁腏腜腐腒腟腃腐腘 腜腞腋腆 膝臀 腛腊腎腜 1 腓腍腝腔 腘腜 2 膵臇 腉腂腏腜 腋腗腌 1 腃腃 臖膢 腔腝腟腆 3 膟膲腅腇 4 腖腑 腐腂 2 膽膂 腕腙腃腄 腊腒腗腉 2 臔臚 腃腃腓腚 膒膾 腑腈腗腔 1 膱臱 : 臸臂 21 8 24 膎臍臘膃臨膜膥 ultrasonography, 腹膄 US腗臎膁腱腴腨腵腫腶腰腳腀腭臕臋contrast enhanced helical computed tomography, 腹膄臎膁 HCT腚膎腚臯膴臧腦臓臫腌US 腄腉腣膎臍腚臞腼腦膠腥膡腇腙膜臡腌腑臠膀腙腄腂腕 2004 9 膛腅腡 2008 3 膛腚膑膏腙 US 腖膎腦膫臜腋腤腑 9647 腚腃 US 膬膢臉膠 3 腨膛腹臣腙臎膁 HCT 腦膢腓腑 511 1281 臰臺腦臓膺腗腌腑US 膕腜臎 HCT 腂腎腤腅腚膜膥腖膜膴腖腇腑膎膿腦臵臻腗腌腕臵膪腙 US, 臎膁 HCT 腏腤腐腤 腖膜膴腖腇腑膎膿腗腌膜膴腗腌腑腝腑US 腗臎膁 CT 腚膎臣臆膗臁臰臺 space occupying lesion, 腹膄膎臣 SOL腗腌腕腚膎腚膜膴Couinaud 腚膎腷膘腼臵 腹膇腚膎臣臆膗臁臰臺腚腊腅臩膚膎 臃膼臌膙bright liver 臁膎膮膍膓 腂膙臒膉腙腠腣膤 BMI 腖臲臙臒膳膙臛臒膳膙膙腙臵腙腔腂腕臫膊膜臡腌腑臎膁 HCT 腚膎膜膴臊腕腚膎腷膘腼腙腄腂腕90腖腁腓腑US 腚膎膜膴 腦膈腷膘腼臹腙膜臡腍腣腗S1 S2S3S4S5S6S8 腙臫腌腺腙臛腈 P0.05S7 S2S3S4S5S6 腙臫腌腺腙臛腈 P0.05S8 S2S3S5 腙臫腌腺腙臛腈 P0.05S2 S1S6S7S8 腙臫腌膣腅腓腑 P0.05腊腚腊腗腠腢US 臞腼腛 S1S7S8 腙臐腈臏膧腍腣腊腗腆臵腅腢膔腙S2 腛臊腷膘腼臗臞腼腆膦腟膶腘腅腓腑腸臁膰臷臏腛臭臷臏腙臫腌US 腚膜膴腺腙臛腅腓腑 P0.05臃膼臌膙腙 臫腌bright liver 膙腖 US 腚膜膴腺腙膣腅腓腑 P0.01臛臒膳膙腄腠腜臬膙腖臃 膼臒膳膙腙臫腌US 腚膜膴腺腙膣腅腓腑 P0.05US 臞腼腦腡腅腙腍腣腑腞臎膁 HCT 腦臓膹腗腌腕膎腷膘腼臹腙膎腚膜膴腦膩膴腌腏腚膞腾腙腔腂腕膜臡腌腑ῐῌ῏ 臘膃臨CT臞腼膎腷膘腼 致至臘膃臨膜膥膕腜 CT 膜膥腛膎臍腚臆膗臁臰 臺腚腬腩腴腀腯腶腪腙腄腂腕膷膻腊腍腘膜膥腖腁 1 臄腲腴腧腶腮腻膆臔膋 膇膆膋 膸膅膐腽自膇膆2 膷膜膥腻膋 3 臼膯臈膆 4 臣膆膋 膸膅膐膎臍臣膆239 63

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Page 1: Vol. 37, pp. 239 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37... · Fig. 1. Detection numbers of liver cysts by ultrasonography or contrast-enhanced helical computed

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Page 2: Vol. 37, pp. 239 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37... · Fig. 1. Detection numbers of liver cysts by ultrasonography or contrast-enhanced helical computed

�������������� US ������ 1 ��������������� ��� US ��� ����� �������� �!� ����"�!#� �$�%�&��#������ ���'�()���1�� *)(�� ����+,� �������� �!��-.�����/�' 0()� ����"�!#�$�%�&��#�.12.!��3�456782����"#���9�:� ���$��;<'������%=&>� �?''��� ����(�)*+,9-@���' 0()������A)������ SOL �B. US �/C CT �0DB1�� Couinaud ��E&�233�4 US ��� ��B1 FG�5HIJ��K�'6L�M�N��� O7(1��5H�P���� �Q8R9: 116: 177;< =>��� US ��. STU�B1����'� �:�V< =>���W����� US ?� �X@�� �AB'CDE:�G����Y� SOL BF�ZG�0DB1�����[\)�� US �B���]G�;<� S4� S8 �����!� S2� S3 �$�%��#� S6 ���H):IY� J�^�� ��_.K `L�����P����MDNON��PQRa���� SOL ��

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��8 US�rs�^tu� _�����B']v���� `�Js� CT a bw� /C CT�W/CA)x CT a'<\(������/CCT ��NcW]v���6�� ��8*���+,������x)�E&�](W���y��jk()��Y� Couinaud ��E&�4� US ���/C CT��B. dz��=>���y�� Helmberger (7�/C CT � MR Nc��{K�|IK}��� US, ~m4�15����e/CB��0L�e)�N�� ��fg�Nc�dh��h/C CT, MR �W 80�95������5H����� ��� Wernecke (8�M�K�fg�B�h' US � 53�=��/C CT � 68�����5H����� *��Y7���� US ���8 `LA)���9:

N��� US ��W� �'i���jk()�/C CT =j���� ��8�BFN��BA)��E&� 0DB1�� US �� ��*�+, \(]��� ��� ��8�%���k�K;<��^� l��� ���G�� BF�'��]���W0DB1���

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Aquillion4 ������� ~.¡ ��� Asteion4������� ~.¡ ��� Aquillion16 ������� ~.¡ �� ���� /C­®��300mg�ml ��� 370mg�ml 600mgI�kg ������ ®�� 300 mg�ml �/C­���h2.0�4.0ml�s, ����� 150ml,®�� 370mg�ml�/C­���h 1.7�3.3 ml�s, ����� 100ml ���� .12.¯ 0.5�3 mm, >� °¨40.828�1.5������%=&��«��,���«�±� b�Js���' EIZO �� L577 �²�h 12801024°7³ � ´h 250 cd�mm2� �µ¶·?�� /C HCT N�� US rC��� /C HCT ���x�59rC5H� �x�^c�|¸��|rC���US ��B�x'¹U��B�o��ºA)�����8��J�^��p'��A)����

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Page 3: Vol. 37, pp. 239 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37... · Fig. 1. Detection numbers of liver cysts by ultrasonography or contrast-enhanced helical computed

���������� HCT� US � ����������������� HCT � ����������� US ��� US ������ ���� US !"�#�$�%&�'()��*�+,������ US ��� HCT ����-��.+���������������/0�� 1&2&.+����3��� HCT 4��5�6� US � )����7�89�:�;�<� �7�=>�<?� �@�AB()�?�� �C�� �D��E,6� F<����6�G�H+I�� 89��<�7�� HCT J� �KL���MN�����O-&��PQ����� �7�=>�<?��?RS� 2 cm F���)���� �@�AB()�?��@B�?�-�2 cm F���)���� �C��T�U ��V!WX"���+@?��6�O-&��� 7?��7���YZ�67?�[�,\]�-���+,9� 10� 11�� #^J� _`#a�b+,�$�V!RS@B�E%!@c8H�RS&B��@��B()��C����� �D��d%� 2 cm F���)�������� Couinaud��'()'()� US� HCT �1&2&ef��� %-�������SOL �*+� &g�� Yh�i�RS1&2&<$�,�j'(���

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body mass index �F< BMI� �R�'(12��F,�BMI 18.5 FJ 25GE�HIY�k� BMI 25 FJ�DEk� BMI 18.5 GE�JY�k���� US��D� 3��F��AK�3�\��L�������M�F,�� �NtY��O�+�5��A��� Yh�R�'(� �� 3505��S� yzY�k 243 5� JY�k 68 5� DEk 39 5��I��US ¡{ HCT ,¢&������£���

�����'P��� '¤� US \�� HCT���£���� ¥&������£Q����+ � ¦§¨©#����� R�S2ª«��6¬� ��1503�%&��TfU ­2�� c2 � R{®k¯��U�Ryan ����*°±² 5���F,��

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�£%&����� �� 1281³�� 1�´µUS ��£%&����� 762³� HCT ��£%&����� 1147 ³��I�� US R{ HCT �R�����V�%�¶· 1.5mm �-¶V 55.0mm \��� W¸� 6.89�1.7mm ��I�� �]�� US � HCT �������������������-¢� 1�¹�f�M�TX���/0�� HCT ��f�M�F,��º»�£%&������ Couinaud��'()

'()� Fig. 1 ���� �����£� �US ��£³� � HCT ��£³� �º»�£%&����� ��� S1 �9�39�42�� S2 �144�169�197�� S3�114�149�164�� S4 �142�212�235�� S5 �119�149�172��S6 �89�140�157�� S7 �59�140�148�� S8 �86�149�166���I�� �����£Q� Couinaud��'())� Fig. 2 ���� �����£Q �US��HCT��� S1 �21.4�92.9�� S2 �73.1�85.8�� S3 �69.5�

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65

Page 4: Vol. 37, pp. 239 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37... · Fig. 1. Detection numbers of liver cysts by ultrasonography or contrast-enhanced helical computed

Fig. 1. Detection numbers of liver cysts by ultrasonography or contrast-enhanced helical

computed tomography by Couinaud[s liver subsegmentation.

�US: detection numbers of liver cysts by ultrasonography. �CT: detection numbersof liver cysts by contrast-enhanced helical computed tomography. S: Couinaud[s liver

subsegment. S 1: caudate lobe, S 2: posterior lateral segment, S 3: anterior lateral

segment, S 4: quadrate lobe, S 5: anterior inferior segment, S 6: posterior inferior

segment, S7: posterior superior segment, S8: anterior superior segment

Fig. 2. Detection rates of liver cysts by ultrasonography or contrast-enhanced helical

computed tomography by Couinaud[s liver subsegmentation.

Contrast-enhanced helical computed tomography exhibited detection rates of about 90

� for all liver subsegments, with no remarkable blind spots observed in any

subsegment. The US detection rate was significantly lower for S1 than for S2, S3, S4,

S5, S6, and S8; significantly lower for S7 than for S2, S3, S4, S5, and S6; significantly

lower for S8 than for S2, S3, and S5; and significantly higher for S2 than for S1, S6, S

7, and S8. �US: detection rates of liver cysts by ultrasonography. �CT: detectionrates of liver cysts by contrast-enhanced helical computed tomography. S: Couinaud’s

liver subsegment. S1: caudate lobe, S2: posterior lateral segment, S3: anterior lateral

segment, S 4: quadrate lobe, S 5: anterior inferior segment, S 6: posterior inferior

segment, S7: posterior superior segment, S8: anterior superior segment

���� ���� �242

66

Page 5: Vol. 37, pp. 239 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/3734/3,4-37... · Fig. 1. Detection numbers of liver cysts by ultrasonography or contrast-enhanced helical computed

90.9�� S4 �60.4 �90.2�� S5 �69.2 �86.6�� S6 �56.7 �89.2�� S7 �39.9�94.6�� S8 �51.8�89.8�� �� �59.5�89.5� ������������� �������� Ryan

������� ���� 5������� US ������ S1 � S2� S3� S4� S5� S6� S8 ������ !� S7 � S2� S3� S4� S5� S6 ������ !� S8 � S2� S3� S5 ������ !� S2 �S1� S6� S7� S8 ������"#��� $%HCT �������������&'�()&#����*+,-./0123����4&#���� 5� S7� S8��� 31467 746�8� 23.6�9��:;&#��� �*+<=>3?����4&#���� 5� S6 ��� 157 67 26 6�8� 16.6�9��:;&#��� �@+ABC?D����4&#���� 5� S2� S3 ��361 67 18 6�8 5.0�9��:;&#��� S1����4&#���� 5� 42 67 33 6�78.6������ �EF����4&#���� 5� S4� S5� S8��� 57367 436�8� 7.5�9��:;&#���

� �� SOL �������G SOL ��H�IJ�� ���5 �US ���65 �$% HCT ���65 �KL��:;��� �M5���G SOL H� �570�832�927�� �GSOL �8 �192�315�354� �� �� ��� �US� �$% HCT���� �G SOL H� �61.6�89.8�� �GSOL �8 �54.2�89.0�������G SOL �NOP�QRSJT� �� ���5 �US ���65 �$% HCT ���65 �KL��:;��� �M5��NP�G SOL �82�116�136�� OP�G SOL �110�199�218� �� �� ��� �US��$% HCT�� �NP�G SOL �60.3 �85.3��OP�G SOL �50.5�91.3����� �Table 1��US���G SOL�����G SOL�UV�I

8��� 3�� �P�0.05�� :W�� OP�GSOL��NP�G SOL���� ������9 3�X�� �P�0.05��Y�� $% HCT ���� �����G SOL

��H&WZ��G SOL �NOP�[W\ 90�E]��8� ��'�()&#���

� ������^_��QR�IJ�� ���5 �US ���65 �$% HCT ���65 �KL��:;��� �M5��`abc �463�715�784�� bright liver c�98�104�131�� dP�efg�c �201�328�366� ���� ���� �US��$% HCT���`abc�58.9�91.0�� bright liver c �74.8�79.4�� dP�efg�c �54.9�89.6����� �Table 2��

Table 1. Detectability of Liver Cysts by Ultrasono-

graphy or Contrast-enhanced Helical Computed To-

mography with or without Liver SOL

Detection rates of liver cysts with malignant SOL were

significantly lower than those of liver cysts without

SOL or with benign SOL. US���: detection rates ofliver cysts by ultrasonography. CT���: detection ratesof liver cysts by contrast-enhanced helical computed

tomography. SOL: space occupying lesion. Chi-

square: P�0.05.

Table 2. Detectability of Liver Cysts by Ultrasono-

graphy or Contrast-enhanced Helical Computed To-

mography with or without Liver Parenchymal Disease

In comparison with the normal image group, the

bright liver group exhibited a significantly higher

ultrasonography detection rate. US ���: detectionrates of liver cysts by ultrasonography. CT���: detec-tion rates of liver cysts by contrast-enhanced helical

computed tomography. Chi-square: P�0.05.

hij�k��Glm�nop 243

67

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US���������� bright liver�������� ��������� �P�0.01�� ��HCT ���������� ��������� �P�0.01��

�� ������������ �US���� ��� HCT���� � ��� �����!���� ��"#� �359�592�644�� �"#� 93�122�140�� ����50�64�73� �$%�� ���� �US����HCT�� �� ��"#� �55.7 �91.9�� �"#��66.4�87.1�� ��� �68.5�87.7��$%� �Table 3��US ���������"#�&'(�����

������ ��������� �P�0.05���� HCT ��)�������� �*����+%��

Couinaud �,-.��/�012��.���34� �567��$713�� �8�9:�;���<=�>?� Couinaud�,-.��>? �56����@�A 6���� HCT ��� B5�,-.�&65 90�

CD���A��� ,-.��� ��E.����+%�� US ��� S1� S7� S8 � S2� S3�

S5 ������� ��F� ��� S1� S7 ��� S2� S3� S4� S5� S6 ���5� ���� ��+%�� ��� S2 � S1� S6� S7� S8 ��������� �G+%�� @�@�+��US��E.� S1� S7� S8�HIJ� �� S1� S7�KFHIL7@���+M� ��� S2 �B,-.N�E.�34O�6�P�QR�STUV����W�+%����� S7� S8�B�� 314�N 74�$M� 23.6��� ��+%�� XC'MYZ �567QR�STU���E.�$7@��[\L7� ]��14�4PQR�STU�� US ����^%�_�`� 18 �N 5 � �27.8�� ��<J5&M�a��bc�4de[\L7�P�fg��h���W�+%�����S6 �B�� 157�N 26�$M� 16.6��� ��+%�� XC'MYZ �567P�fg��h��E.1��[\L7� @��i��hj�k;�lmf����n�o��$7��p�� ��M� qrstu��v�'Mp�� �7�wx��7�y�z{-.�h����W�+%����� S2� S3 �B 361�N 18�$M 5.0��� ��+%�� S2� S3 ������ |�}��73.1�� 69.5��~�,-.���G6���$7� |�� �J5y�z{-.�h�������J�GF� @��'My�z{-.����GF�%�@���� �7� y�z{-.������AW�L���J5�!"� y�"�����J5HIL7@��'Mp�� �7����$7� Clarke�15�� US�'7�#���� ,-.���$����6�� y�z{-.� 77.5���<J567� a���<���mm���G6��C�W���59:�;�����@��'74���� �7� 9:�;�����9:�����m|�����16��$7TGC �time gain compensation�� ���� ��� T¡u� N¢£�����'MyP �7�¤��¥� ;¦�§%�'M¨JF��©ª�«�M� ¬­��O�6®����$7@��'F¯��567� a��D��W����°±�� K²�9:������K³��;¦�'M&���9:�;®�A4�������E�$7�´��7� �^J� '�uµ¶T·�¸;�&¹7

Table 3. Detectability of Liver Cysts by Ultrasono-

graphy or Contrast-enhanced Helical Computed To-

mography with De#erent Body Weight Groups

The ultrasonography detection rates of liver cysts were

significantly higher for both the low body weight

group and the high body weight group than for the

normal body weight group. US���: detection rates ofliver cysts by ultrasonography. CT���: detection ratesof liver cysts by contrast-enhanced helical computed

tomography. Normal body weight group: 18.5�BMI�25.0. Low body weight group: BMI�18.5. Highbody weight group: 25.0�BMI. Chi-square: P�0.05.

º�»¼ �()* �244

68

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���������������� �� ��������������������������� US ���� �!�" 9647 ���Couinaud ��#$� ��%&�'(� �)!*�+!��,��� 511��-��.�"/���01� US ���.��2���3,�4���� 56)78��)9.��:,�9,;�<*=�*� 0>�?����56)�.�"@A��BC�D,�E�F��,)",�4G�S1 �.�)9H&"��(� 42 '� 33 '

� 78.6��=&"� US ��,� S1 ���.�*�I�JK� S1 * US �2EL�����=�/�*M!�"� S1 *����9�NO���� P��=�/�QR���ST*=�/�������UVW�XY*=�"Z�[\]����5��.�)9H&"��(� S4� S5� S8

�^� 573'� 43'�� .!�9H&"��7.5��=�� .���K9,� ������_ `*�!��"&�� �!�3K�ab#�$.�%c]��*� 23����de�fVghijklVmno�=�� �_ `*pX!��/�*&]��,�17���� SOL �'(��� ���� �� SOL ������ US �.�� 7.4���q�)Z"�!]�� J<�� SOL ��*<�� SOL �+��.�� 9.8���q�)Z"� ,r��.��qE,st-�'uB�)Z" �P�0.05�� v�./���� �w*�� SOL �-01�� !]�J<�� SOL �x&"@A�b#�$.�+y-2Kz{�3Q/������ SOL |}��~����*��vH�9��,&"�.-4O*=�E��4���� 01� �� SOL �5�Qv�<��:,���.��BC����9&�,9,*� /�]�O������.�*6��;�<�=���7� 8� HCT ����.���� SOL

�'(9]���� SOL �*J<��]r 90�5>�=�� ��<�9�"��=��,\��:����� ���� US �.��� �Ie� 58.9��+�� bright liver � 74.8��� 'u��,� v�./���� �~����V�������������~���n����*DK"Z� US ������.�*���"�[\�� �7� 8� HCT �.���Ie� 91.0��

+�� bright liver� 79.1��� 'u��,� brightliver ���K�@A� ���;���!���,�E��4��� v�����~�� CT�*�q�� ����~���n����*D)�KK9�� 8� HCT �.�*�q�"�[\��<��B��� ���� US �.��� �I<_� 55.7��+�� �<_� 66.4����=>� 68.5��� �<_��=>�*'u��,� �<_�����������UVW�XY*�9,"Z� US �.�*�K9&"E��4����=>��� bright liver �A?�* 35.7�����=�� ����~���n����*DK"Z�US �.�*�K9&"E��4���� "��� =>����I<_���E��* K� ��������UVW�XY*�),�[\]����H�� US �.��� �I<_��+�� =>��'u��,� ��������UVW�XY��E bright liver ����n�����¡������*���),/�*¢£!���Emillio ]17��� @¤<�bA 160 �����

�8�US��@¤<�bA�B¥.(* 2.21�1.60'�=&"��C��� �¦U������8�US�B¥ 3.10�2.44'�� 'u�8�US�.�*9����� 8� HCT ��B¥.'(3.05�2.41'�DE�=&"� 8� US �@¤<�bA����x&"@A�'§9¨©�=�*� ����jªVhno���������I�F,]��/��9,� %&�� GI� US��I����*=�/��H+��� �I^<�����*«�J4*=��

� �

01� US ������]H��"Z� 8�HCT �C¬���� �#$�K����.��­.�� v�NO�D,���"�

����

1� ®L¯M� N�OP� °Q3R� ±²³R. bA�´µ��H]-"�¶·� US $.�.��de¸S 1995; 15: 296�301.

2� �LTU. ����t¹V. ³�º� W»�2000: 267�268.

3� Couinaud C. Distribution De L[artere Hepa-tique dans Lefole. Acte anat 1954; 22: 4�81.

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7� Helmberger T, Rau H, Linke R and Reiser M.Diagnosis and staging of liver metastases with

imaging methods. Chirurg 1999; 70: 114�122.8� Wernecke K, Rummeny E and Bongartz G.Detection of hepatic masses in patients with

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genol 1991; 157: 731�739.9� '!()� *+,� -./�. 012�345678456. �7�. 2003; 24: 81�89.

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Paris, 1989: 123�134.12� 9:;<� =>?@� A.BC� D.EF� G

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14� GH�� A.�<� �.�� �.�U� ��IX� ����� �.�W. ������������7a��8���� �US� 7 X � CT�CT� �hi��7�6. ���  1992; 17:505�510.

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Abstract

Definition of ultrasonographic blind areas in the liver:

A comparative investigation of the detection rates of

liver cysts in contrast helical CT and ultrasonography

Masasumi Miyazaki1, Fumio Tsujimoto2, Satoshi Koizumi1, Tomoyuki Ota3,

Gaku Igarashi4, Seiji Hatano2, Sachihiko Nobuoka2, and Takeshi Otsubo1

We compared the functions between ultrasonography �“US”� and contrast enhanced helical computedtomography �“contrast HCT”� for visualizing liver cysts, and conducted a retrospective investigation ofultrasonographic blind areas in the liver.

Of the 9,647 cases diagnosed with liver cysts using US at our hospital between September 2004 and

March 2008, we evaluated 511 cases comprising 1,281 lesions in which contrast HCT was conducted within

3 months before or after US. We defined the number of liver cysts detected by either US or contract HCT

as the denominators and defined the respective numbers of liver cysts detected by US and contrast HCT as

the numerators in order to calculate the detection rates of liver cysts. The detection rates of liver cysts by US

were compared with contrast CT according to Couinaud[s liver subsegment classification, the presence or

absence of liver space-occupying lesions �“liver SOL”� other than the liver cysts, the liver condition �caseswith normal findings, cases with bright liver, and cases suspicious of chronic liver disease�, and di#erencesdue to physique �cases were classified into a normal weight group, an underweight group, and an overweightgroup based on body mass index�.The detection rate of liver cysts by contrast HCT was approximately 90� in all hepatic subsegments.

When the detection rate of liver cysts by US was investigated for each subsegment, the rate was significantly

lower in S1 compared to S2, S3, S4, S5, S6, and S8 �P�0.05�, significantly lower in S7 compared to S2, S3,S4, S5, and S6 �P�0.05�, significantly lower in S8 compared to S2, S3, and S5 �P�0.05�, and higher in S2compared to S1, S6, S7, and S8 �P�0.05�. These results revealed that many blind areas by US occurred inS1, S7, and S8, and conversely, S2 had the fewest blind areas among all of subsegments.

Cases with a concomitant malignant tumor had a significantly lower detection rate by US compared to

cases with no concomitant malignant tumor �P�0.05�. Compared to cases with normal findings, cases withbright liver had a significantly higher detection rate by US �P�0.01�. Compared to the normal weight group,cases in the underweight group and the overweight group had significantly higher detection rates by US �P�0.05�.In order to clarify the liver blind areas by US, we evaluated a comparison with contrast HCT and

calculated the detection rates of liver cysts in each hepatic subsegment to investigate the cause of such blind

areas.

1 Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine2 Department of Laboratory Medicine, St. Marianna University School of Medicine3 Department of Radiology, St. University School of Medicine4 Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine

����������� � 247

71