This study was designed to evaluate digital subtraction imaging (DSI) with Levovist in the diagnosis of hepatocellular carcinoma (HCC), metastatic hepatocellular carcinoma, and hepatic hemangioma. The subjects in this study were 70 patients with 76 nodules of hepatic tumors (48 nodules in 46 cases of hepatocellular carcinoma, 20 nodules in 16 cases of metastatic hepatocellular carcinoma, and 8 nodules in 8 cases of hepatic hemangioma). Contrast enhancement of tumors acquired in the early, portal, and late phases with DSI were compared to classify the tumors. DSI of HCC showed contrast enhancement of 40 nodules (82.2%). High contrast enhancement in the early phase, which was maintained in the portal phase, changed to images with no contrast enhancement with partial persistence of contrast enhancement in the late phase. DSI of metastatic hepatic carcinomas demonstrated contrast enhancement of tumor of 18 nodules (90%) to a high degree in the early and portal phases, which changed to images with no contrast enhancement in the late phases. DSI of hepatic hemangioma maintained high contrast enhancement on tumor margins of 5 nodules (62.5%) and on the entire tumor of 3 nodules (37.5%) in the early, portal, and late phases. DSI of hepatic tumors (hepatocellular carcinoma, metastatic hepatocellular carcinoma, and hepatic hemangioma) provided characteristic findings of contrast enhancement in the early, portal, and late phases, and contribute to differential diagnosis.

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