Clinical Study Of Double Real-time Gray Scale Enhanced-ultrasonography In The Diagnosis Of Liver Neoplasms

OBJECTIVE To investigate the characterization of solid liver lesions on double real time gray scale contrast ultrasound as well as its value in the differential diagnosis of solid liver lesions when compared with baseline ultrasound.METHODS Eighty patients with various liver neoplasms were examined by double real time grey scale contrast enhanced ultrasound with an intravenous injection of Sonovue. Among them, 29 were hepatic cellular carcinoma(HCC),11 were metastatic hepatic carcinoma(MHC),19were hepatic hemangioma (HCH), 15 were focal nodule hyperplasia (FNH),3were cirrhosis nodule,1 were tuberculosis nodule, and 2 were focal fatty liver. These cases were all diagnosed pathologically through operation or ultrasound-guided aspiration biopsy. To observe the dynamic course and characteristics of enhancement of different solid hepatic lesions. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated by considering histologic analysis, and which were compared with that of baseline ultrasound.RESULTS After injection of Sonovue, different lesions showed different enhancement patterns. Among 29 cases of hepatocellular carcinoma, 24 had dramatic diffuse enhancement in artery phase followed by immediate wash-out in portal vein phase or in delay phase, andpresented hypoechoic appearance in delay phase; 2 presented absent ofenhancement throughout the whole courses; 2 showed dottedenhancement in artery phase, then keep persistent enhancement and hadan isoechoic appearance during the delay phase. Among 11 cases withliver matastatic carcinoma, 9 had distinct enhancement in artery phaseand began wash out in portal vein phase; 2 were not enhanceddramatically throughout the whole phases, and all the cases presentedhypoechoic appearance in delay phase. Among 19 cases of hepatichemangioma, 14 were enhanced dramatically, beginning enhanced withtypical peripheral nodule-like enhancement during the artery phase orportal vein phase followed by progressive centripetal filling in rapidly orslowly throughout the whole courses and presented filled up withcontrast agents wholly or partially;5 small cases had not distinctenhancement in artery and portal vein phase, while presentedlow-graded enhancement during the delay phase. And their durationtime of enhancement were 208.3s,which were remarkably longer thanthat of live malignant tumor (58.1s in PHC,59.1s in MHC)(p<0.05).Among 15case of liver focal nodule hyperplasia, 10 were enhancedremarkably, a tortuous spoke–like vascularization from center tooutward were observed in artery phase, and had diffuse enhancementduring portal vein phase, and then their enhancement last throughout thedelay phase; 5 had diffuse enhancement during the artery phase andkeep enhanced and had isoehoic appearance in delay phase, theirduration time of enhancement were 189.6s, which were remarkablylonger than that of live malignant tumor(58.1s in PHC,59.1s inMHC)(p<0.05). Among 3 case of cirrhosis nodules, 2 present theenhancement that be approximate with that of around liver parenchyma;1 were not enhanced during artery phase and had dotted enhancement inportal vein phase and presented some low echoic nodule. 2 cases offocal fatty liver had the same enhancement with that of around liverparenchyma.1 case of liver tuberculosis nodule presented absent enhancement during the whole phase. According to the dynamic change and the different enhancement during the delay phase, lesions were diagnosed as benign tumor or malignant tumor, the standard were as followed ①malignant lesion: the enhancement was faded rapidly and the lesion presented hypoechoic appearance during delay phase.② benign lesion: the enhancement was lasted persistently and had hyperechoic or isoechoic appearance during the delay phase. Then sensitivity, specificity, accuracy, and positive and negative predictive values with contrast enhanced ultrasound were remarkably different from that with baseline ultrasound.Conclusions Different solid focal liver lesions presented different enhancement patterns in the double real time contrast-enhanced ultrasound, which provide basis for the diagnosis and differential diagnosis of liver tumors and make the diagnosis accuracy to be enhanced. Double-mode grey scale imaging can allocate lesions accurately, which makes it easy for us to observe the enhancement of lesions all time especially in artery phase. So there is better prospect for double-mode grey contrast enhanced ultrasound.