Clinical Value Of CEUS In Predicting Early Postoperative Recurrence And Postoperative Follow-up Monitoring Of Hepatocellular Carcinoma

Part I:Clinical value of CEUS in predicting microvascular invasion and early postoperative recurrence of hepatocellularcarcinomaObjective: The correlation between preoperative indexes based on contrastenhanced ultrasonography(CEUS)and microvascular invasion(MVI)and early postoperative recurrence of hepatocellular carcinoma(HCC)was analyzed.Investigate the clinical value of CEUS in predicting MVI and early postoperative recurrence of hepatocellular carcinoma.Methods: From March 1,2013 to October 1,2016,76 patients with liver cancer underwent radical resection in our hospital.Conventional ultrasound(US)and CEUS were performed before operation,and according to the pathological results after operation,76 patients with liver cancer were divided into MVI positive group and MVI negative group,and followed up in cohort after operation.Univariate analysis was used to compare the clinical indexes,conventional ultrasound and contrast-enhanced ultrasound findings between MVI positive and MVI negative patients,and the independent risk factors of MVI were analyzed by Logistic regression multivariate analysis.Cox proportional hazard regression model was established to predict the prognosis of early recurrence of liver cancer(within 24 months).Results: Among 76 patients with liver cancer,MVI was positive in 25 cases and negative in 51 cases.(1)Univariate analysis showed that there was no significant difference in sex,age,Child-Pugh grade,cirrhosis,tumor location,Intratumoral necrosis and high enhancement of CEUS arterial phase between the two groups(all P > 0.05).There were significant differences in serum AFP,tumor size,tumor number,tumor margin after CEUS enhancement and rapid regression of portal phase(all P < 0.05).(2)Logistic regression multivariate analysis showed that the number of tumors(OR=5.477,P=0.017),tumor margin after CEUS enhancement(OR=4.92,P=0.028)and capsule type(OR=2.396,P=0.04)were independent risk factors for MVI;(3)COX regression multivariate analysis showed that capsule type(HR=2.365,P=0.014)and MVI(HR=3.37,P=0.039)were risk factors for early recurrence of HCC after radical resection.Conclusion:(1)Patients with multiple tumors,tumor capsule defect or no capsule and unsmooth tumor margin after CEUS enhancement have a high risk of developing MVI before operation.(2)The patients with tumor capsule defect or no capsule and MVI positive had a high risk of early recurrence after operation.(3)Preoperative CEUS can predict the risk of microvascular invasion and early recurrence of hepatocellular carcinoma,and is helpful to screen patients with high risk of early recurrence and choose reasonable treatment.Part 2:Clinical value of CEUS in postoperative follow-up ofHepatocellular carcinomaObjective: By analyzing the enhanced characteristics of contrast-enhanced ultrasonography(CEUS)of recurrent hepatocellular carcinoma(RHCC)and highly dysplastic nodules(HGDN)with intrahepatic diameter ? 3.0cm,and the ability of CEUS to detect arterial vascularization in RHCC,To explore the clinical value of CEUS in postoperative follow-up monitoring of hepatocellular carcinoma(HCC)and the establishment of monitoring and diagnosis process of postoperative intrahepatic nodules in HCC.Methods: 369 patients who underwent radical resection of liver cancer in our hospital from February 2015 to March 2017 were followed up and monitored by conventional ultrasound.The follow-up period was every 3 to 6 months.US found suspected recurrent nodules and selected the subjects in strict accordance with the inclusion criteria.A total of 97 patients(124 nodules)who finally met the inclusion criteria were analyzed and summarized the enhancement characteristics and enhancement patterns of RHCC and HGDN in each period of CEUS,and by analyzing the enhancement features of CEUS and CT/MRI of RHCC in arterial phase.To compare the detection ability of CEUS and enhanced CT/MRI in the vascularization of RHCC artery,and to draw up the monitoring and diagnosis process of intrahepatic nodules after liver cancer surgery by referring to the relevant guidelines.Results:(1)The contrast-enhanced ultrasound findings of RHCC and HGDN with diameter ? 3.0cm were characteristic.The arterial phase of RHCC was mainly high enhancement(97.0%,96/99),and the portal phase and delayed phase showed low or equal enhancement.The enhancement mode was mainly "fast-in,fast-out" type and "fast-in and slow-out" type,accounting for 36.4%(36/99)and 60.6%(60/99),respectively.(2)If the typical enhancement mode of "fast-in and fast-out" was used as the basis for the diagnosis of RHCC,the diagnostic accuracy was only 36.4%(36/99),if combined with the clinical data such as the history of liver cancer and the increase of serum AFP,only the high enhancement of the lesion in arterial phase,that is,"fast forward",was used as the basis for the diagnosis of RHCC.The diagnostic accuracy was increased to 97.0%(96/99),the sensitivity was 97.0%,the specificity was 68.0%,the positive predictive value was 95.1%,and the negative predictive value was 85.0%.(3)The arterial phase of HGDN showed local or global high enhancement,portal phase showed equal enhancement,delayed phase showed equal enhancement or mild low enhancement,and the enhancement mode was "fast in and out";The contrast-enhanced findings of HGDN overlapped with some RHCC,and it was difficult to distinguish them from each other.(4)The detection ability of CEUS for arterial vascularization of RHCC was higher than that of enhanced CT/MRI(P value<0.05),the sensitivity was 97.0% VS 71.7%,the specificity 68.0% VS 72.0%,the positive predictive value 92.3% VS 88.8%,the negative predictive value 85.0% VS 39.1%.Conclusion:(1)CEUS has certain diagnostic and differential diagnostic ability for RHCC and HGDN with intrahepatic diameter?3.0cm;(2)CEUS has a strong ability to detect the vascularization of RHCC artery,and can supplement the diagnosis of RHCC with atypical or missed diagnosis of CT/MRI,and can detect RHCC and hyperplastic nodule canceration in the early stage;(3)CEUS plays an important role in the monitoring and diagnosis of intrahepatic nodules in patients with HCC,and plays an important role in the follow-up monitoring of early intrahepatic recurrence in patients with HCC.