The Diagnosis Of Focal Nodular Hyperplasia Of The Liver By Contrast-enhanced Ultrasound And Comparison With Contrast-enhanced MRI/CT

Objective: To discuss the contrast-enhanced ultrasound(CEUS)features of focal nodular hyperplasia(FNH)of the liver,evaluate the diagnostic value of CEUS in FNH,and compare with contrast-enhanced magnetic resonance imaging(MRI)and contrast-enhanced CT.Methods: The conventional ultrasonography and contrast-enhanced ultrasonography data of 40 patients diagnosed as FNH by pathology were analyzed retrospectively.The size of the lesion and the rate of characteristic ultrasonographic findings between male and female patients were compared.The lesions were divided into two groups according to the boundary of 3cm,the rate of characteristic ultrasonographic findings between the two groups was compared.To calculate the diagnostic coincidence rate of CEUS,and discuss misdiagnosed cases.In 40 cases,22 cases were examined by contrast-enhanced MRI and27 cases were examined by contrast-enhanced CT.The coincidence rate of CEUS and other two imaging examinations in the diagnosis of FNH was calculated and compared.Results: Color Doppler flow imaging(CDFI)could detect abundant blood flow signals in lesions in 35 of 40 cases(87.50%),and radial blood flow signals could be detected in19 of 40 cases(47.50%).In 40 cases,all lesions showed high enhancement in arterial phase,20 cases(50.00%)showed typical radial enhancement,36 cases(90.00%)showed high or equal enhancement in portal phase and delayed phase,and 9 cases(22.50%)showed low or no enhancement area similar to central scar in delayed phase.There was no significant difference in the size of the lesion and the rate of characteristic ultrasonographic findings between males and females(P > 0.05).There was no significant difference in the rate of radial blood flow,radial enhancement and central scar between the two groups of lesions of different sizes(P > 0.05).Taking pathological results as the gold standard,38 of 40 cases were diagnosed as FNH by CEUS,the diagnostic coincidence rate was 95.00%(38 / 40),2 cases were misdiagnosed as hepatocellular carcinoma,both with liver cirrhosis background.Of the 22 patients who underwent both contrast-enhanced MRI and CEUS examination,19 cases were diagnosed as FNH by contrast-enhanced MRI(coincidence rate was 86.36%),21 cases were diagnosed as FNH by CEUS(coincidence rate was 95.45%).There was no significant difference between CEUS and contrast-enhanced MRI in the diagnosis of FNH(P > 0.05).Of the 27 patients who underwent both contrast-enhanced CT and CEUS examination,21 cases were diagnosed as FNH by contrast-enhanced CT(coincidence rate was 77.78%),27 cases were diagnosed as FNH by CEUS(coincidence rate was 100.00%).The coincidence rate of CEUS in the diagnosis of FNH was higher than that of contrast-enhanced CT,and the difference was statistically significant(P <0.05).Conclusion: The coincidence rate of CEUS in the diagnosis of FNH is similar to that of contrast-enhanced MRI,but higher than that of contrast-enhanced CT,CEUS is the first choice in the diagnosis of FNH.Attention should be paid to the differentiation between FNH under the background of liver cirrhosis and hepatocellular carcinoma.