The application value of contrast-enhanced ultrasound in focal liver lesions / 中国中西医结合急救杂志

ABSTRACT

Objective To compare the difference in diagnostic value between conventional ultrasound and contrast-enhanced ultrasound (CEUS) for focal liver lesions and observe the application value of CEUS in the diagnosis and differential diagnosis of focal liver lesions. Methods Eighty-three patients who carried out conventional examination were diagnosed as focal liver lesions admitted to the Department of Ultrasound in Tianjin Medical University Cancer Hospital from May 2012 to July 2016, and totally 93 lesions were found. The types of lesions were determined by conventional ultrasonography, CEUS and pathology, and the effectiveness of conventional ultrasound and CEUS in the diagnosis of focal lesion types was compared, the time-intensity curve was used to record the beginning time of enhancement, peak time of enhancement, washout time and peak strength in different types of focal liver lesion, that may provide certain characteristics for differentiation of benign from malignant lesions, and the patterns of CEUS in different types of liver focal lesion were observed. Results Pathological examination confirmed the types of lesionsthere were 57 malignant focal lesions in 93 lesions (including 34 hepatocellular carcinoma, 11 cholangiocarcinoma, 11 metastatic tumors and 1 lymphoma in liver), there were 36 benign lesions in 93 lesions [including 16 liver abscesses, 5 liver focal nodular hyperplasia (FNH), 5 hepatic adenomas, 4 hemangiomas, 3 uneven fatty liver, 2 hepatic cysts, and 1 hepatic perivascular cytoma]. By conventional ultrasound 51 focal liver lesions and by CEUS 80 focal liver lesions were correctly diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS in diagnosing focal liver lesions were significantly higher than those of conventional ultrasound 91.23% vs. 68.42%, 77.78% vs. 33.33%, 86.67% vs. 61.90%, 84.85% vs. 40%, 86.02% vs. 54.84%, respectively, the differences being statistically significant (all P < 0.01). All of malignant lesions including the arrival time (seconds 11.17±2.15 vs. 15.92±2.90), the enhancement peak time (seconds 21.13±3.06 vs. 40.93±11.71), the washout time (seconds37.16±6.84 vs. 73.51±11.80) were earlier than those of benign lesions, and peak strength of malignant lesion was higher than that of benign lesions (dB -46.64±3.60 vs. -63.36±15.38), the difference being statistically significant (all P < 0.01). Under CEUS pattern, different liver focal lesions revealed different types of enhancement, but in part of the focal lesions the types of enhancement had manifestations crossed. Conclusions CEUS improves the diagnostic efficacy for focal liver lesions which has great value for differential diagnosis of benign from malignant liver lesions.