Evaluation of contrast-enhanced ultrasound for the diagnosis of dysplastic nodule in liver cirrhosis

Abstract

Objective To observe the enhancement pattern of focal liver lesions in cirrhotic patients and to evaluate the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of dysplastic nodule with hepatocellular carcinoma(DN-Ca). Methods One hundred and forty-one cirrhotic patients with 163 focal liver lesions with the size of 1 - 3 cm were included in this study. All the nodules were examined using CEUS with SonoVue and underwent biopsy. The biopsies were performed using 18G needles in the different parts of enhancement. The enhancement patterns of DN-Ca, HCC and regenerative nodule(RN) were analyzed.Results Twenty-one lesions were diagnosed as DN-Ca by biopsy,45 lesions as hepatocellular carcinoma (HCC) and 97 lesions as RN. All the 21 lesions of DN-Ca presented partial enhancement during arterial phase or portal phase and wash-out during the late phase; the other areas of the lesions presented delayed or simultaneous enhancement during arterial phase and 23.8 % (5/21 ) slight wash-out in the late phase. Of the 45 lesions of HCC,82.2 % (37/45) presented global enhancement during arterial phase or portal phase, and 17.8% (8/45) presented inhomogeneous enhancement with no-enhancement in the central area during arterial phase, 100% (45/45) presented wash-out during the late phase. In 97 RNs, 96.9% (94/97)presented delayed or simultaneous enhancement during arterial phase, 3.1% (3/97) presented slightly enhancement during arterial phase;25.8% (25/97) showed wash-out and 74. 2% (72/97) showed no washout during the late phase. The pathological diagnosis was HCC in the enhanced area and hepatocytes regeneration in the un-enhanced area in the 21 DN-Ca. Conclusions CEUS is helpful in predicting the progress from RN to HCC by analyzing the hemodynamics. CEUS can improve the diagnostic accuracy of biopsy by providing more accurate information. Key words: Ultrasonography; Microbubbles; Liver cirrhosis; Carcinoma, hepatocellular