Diagnostic Utility Of Ultrasonography Contrast Agent Sonazoid In The Diagnosis Of Liver Neoplasms

Objectives: To investigate the diagnostic efficacy of the ultrasonography contrast agent Sonazoid in the diagnosis of liver neoplasms.Methods: Patients with liver-occupying lesions who were treated in the Hainan General Hospital and the Hainan Cancer Hospital from January 2022 to November 2022 were included,and a total of 38 patients with 43 lesions met the inclusion criteria.All patients enrolled in the group underwent conventional ultrasound,Sonazoid ultrasound contrast,and selected characteristic nodules for analysis,and the pathological were obtained by surgery or needle biopsy,with pathological results as the gold standard,to evaluate the diagnostic efficacy of Sonazoid-CEUS in the diagnosis of liver neoplasms.The diagnostic performance of the two imaging methods was analyzed and compared,including the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of Sonazoid-CEUS and enhanced MRI in the diagnosis of liver neoplasms.The vascular phases of Sonazoid-CEUS including arterial phase,portal phase,delayed phase,and postvascular phase enhancement mode of different types of liver neoplasms were observed,and to analyze and compare whether there were differences in the washout time of HCC,ICC and metastases.Results: A total of 38 patients with 43 lesions were enrolled,36 malignant lesions and3 benign lesions diagnosed correctly by Sonazoid-CEUS,and the consistency rate with pathological diagnosis was 90.7%(39/43),The sensitivity,specificity and accuracy of Sonazoid-CEUS for the diagnosis of benign and malignant lesions were 94.7%,60.0%and 90.7%.Among them,24 lesions were examined to Sonazoid-CEUS and MRI examination,and the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of Sonazoid-CEUS examination were 90%,75%,94.7%,60%,87.5%,and the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of MRI examination were 95%,75%,95%,75%,75%,91.7%.,and there was no significant statistical difference in diagnostic performance between Sonazoid-CEUS and MRI(P>0.05).Among the 38 malignant lesions,17 HCC lesions showed hyper-hypo-hypo enhancement(17/18,88.9%),and hypoenhancement in the Kupffer phase(15/18,83.3%),of which 1 HCC showed hypoenhancing from arterial phase to Kupffer phase;ICC lesions were showed uneven hyper-hypo-hypo(5/5,100%),and Kupffer phase showed hypoenhancement or nonenhancement(2/3,40%/60%).The arterial phase of metastases showed heterogeneous high or rim-like hyperenhancement(5/8,38.5%/61.5%),One showed isoenhancement in the arterial phase,hypoenhancement in portal phase and delayed phase(14,100%),and hypoenhancement/nonenhancement in Kupffer phase(5/9,35.7%/64.3%).Hepatic angiosarcoma showed uneven hyper-hypo-hypo enhancement,and hypoenhancement in Kupffer.Among the 5 benign lesions,FNH showed hyperhyper-hyper enhancement,hypoenhancement in the Kupffer phase.2 hemangiomas showed hyper-hypo-hypo enhancement,and nonenhancement in the Kupffer phase.One cirrhotic nodule showed hypo-iso-iso enhancement and isoenhancement in Kupffer phase.forty-five seconds and sixty seconds was chosen as the time cut-off points of the clarification fast and late,and 6 HCCs,3 ICCs and 7 metastases with washout time < 45 s,there were 10 HCCs,5 ICCs and 10 metastases with washout time<60s,and there was no significant difference in washout time between different types of liver cancer(P>0.05).Conclusion: Sonazoid-CEUS,whose diagnostic value is comparable to enhanced MRI,has relatively higher sensitivity and accuracy for the diagnosis of liver neoplasms,and can effectively show the characteristics of blood perfusion of liver neoplasms.Kuppfer phase can provide corresponding information for diagnosis,can be used for liver scan in contrast mode,combined with vascular phase characteristics to improve the diagnostic rate.