| Objective Hepatocellular carcinoma(HCC)is highly invasive,malignant,and has a poor prognosis,which seriously threatens the life and health of our people.Unlike most benign nodules of the liver,abnormal hepatic arterial blood supply is the most important characteristics of HCC.Dynamic enhanced imaging examinations such as contrast-enhanced ultrasound(CEUS),contrast-enhanced computed tomography(CECT),and contrast-enhanced magnetic resonance imaging(CEMRI)can effectively display the blood flow characteristics of focal liver lesions,which are important to early diagnosis of HCC.This study aims to analyze and compare the diagnostic efficacy of three dynamic contrast-enhanced imaging methods used alone or combining for ≤3cm HCC.Methods This study contains 81 patients with 93 focal liver lesions who underwent CEUS,CEMRI,and CECT at Tianjin Third Central Hospital from June 2015 to March 2018.These lesions included 77 HCCs and 16 non-HCCs which contained 2 ICCs and 14 DNs.All the lesions were confirmed by pathological diagnosis.Clinical data,imaging examinations data,and pathological diagnosis data of the patients were collected.Clinical diagnostic test method was used to compare the sensitivity,specificity,accuracy and the AUC of three imaging examinations for HCC as well as in combination.Results The sensitivity,specificity,and accuracy of diagnosing HCC with CEUS was 81.8%,68.8%,79.6%,with CEMRI was 83.1%,68.8%,80.6%,with CECT was 77.9%,62.5%,75.3%.There was no significant difference in accuracy between the three imaging examinations(χ2=0.892,P=0.640,P>0.05).Combining CEUS or CEMRI to diagnosis HCC,the sensitivity,specificity,accuracy was 94.8%,56.3%,88.2%,and the sensitivity is significantly higher than single imaging examinations(χ2=6.291,P=0.012;χ2=5.356,P=0.021;χ2=9.318,P=0.002;P<0.05).Combining CEUS or CECT to diagnosis HCC,the sensitivity,specificity,accuracy was 85.7%,56.3%,80.6%.Combining both CEUS and CEMRI to diagnosis HCC,the sensitivity,specificity,accuracy was 70.1%,100%,83.9%,and the specificity is significantly higher than single imaging examinations(χ2=5.926,P=0.043;χ2=5.926,P=0.043;x2=7.385,P=0.018;P<0.05).Combining both CEUS and CECT to diagnosis HCC,the sensitivity,specificity,accuracy was 71.4%,81.3%,73.1%.The AUC of HCC diagnosed by the three imaging examinations used alone was 0.753,0.759,and 0.702 respectively,which shows no significant difference between them(Z=1.336,P=0.1816;Z=1.272,P=0.2034;Z=0.390,P=0.6969;P>0.05).The AUC in combining CEUS or CEMRI is 0.755,which has no statistically significant difference compared with imaging examinations used alone(Z=0.0352,P=0.9720;Z=0.0594,P=0.9527;Z=0.781,P=0.4350;P>0.05).The AUC in combining CEUS or CECT is 0.710,which also has no statistically significant difference compared with imaging examinations used alone(Z=0.859,P=0.3906;Z=1.037,P=0.2997;Z=0.154,P=0.8775;P>0.05).The AUC in combining both CEUS and CEMRI is 0.851,which is significantly higher than the AUC of CECT(Z=2.067,P=0.0387;P<0.05).And it was also higher than the AUC of CEUS and the AUC of CEMRI,but there is no significant difference between them(Z=1.379,P=0.1678;Z=1.282,P=0.1997;P>0.05).The AUC in combining both CEUS and CECT is 0.763,which has no statistically significant difference compared with imaging examinations used alone(Z=0.193,P=0.8468;Z=0.0752,P=0.9422;Z=1.097,P=0.2726;P>0.05).Conclusion For patients with chronic liver disease,the diagnostic efficacy of the dynamic contrast-enhanced imaging examinations for ≤3cm HCC was similar.This study shows that combining CEUS or CEMRI diagnostic criteria has a higher sensitivity of ≤3cm HCC.And combining both CEUS and CEMRI diagnostic criteria has a higher specificity of ≤3cm HCC.The diagnostic efficacy of combining both CEUS and CEMRI are superior to CECT used alone for the ≤3cm HCC.Compared to the single examinations,CEUS and CECT as well as CEUS or CECT has no significant difference in sensitivity specificity,accuracy and AUC. |
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