The Value Of Contrast-enhanced Ultrasound In Differentiating The Dysplastic Nodule Of Liver Cirrhosis And The Small Hepatocellullar Carcinoma

Hepatocellullar carcinoma(HCC) is a cancer that it has the highest incidence in the world.It occupies the third mortality rate in all of the global cancers and it comes in second in our country.It seriously threatens human's health.But the occurrence of HCC mostly experiences a complex process that begins from viral hepatitis,liver cirrhosis to liver cancer.It is confirmed that the dysplastic nodule of liver cirrhosis is an important precancer to liver cancer.Therefore,the significance of the differential diagnosis for the both sides is very important in early intervention,treatment and the increase of survival rate.ObjectiveTo analyze the perfusion characteristics of CEUS and enhancement duration in liver cirrhosis nodule and small hepatocellullar carcinoma(≤3.0cm),and to investigate the value of CEUS technology in differential diagnosis of the two.Materials and MethodsUsing Sono Vue by real time gray-scale CEUS to observe 44 cases of liver cirrhosis merged space occupying lesion and nodule with 52 lesions(diameter≤3.0cm).Among these cases,21 cases with 26 lesions are diagnosed hepatocellullar carcinoma,23 cases with 26 lesions are diagnosed simplex liver cirrhosis with dysplastic nodule eventually.Analyzing the perfusion patterns and enhancement duration of CEUS,summarizing the contrast characteristics of dissimilar lesions,and comparing diagnoses by surgical or biopsy results and by results which are not carried out contrast examinations.20 cases with 21 lesions of dysplastic nodule are made a follow-up visit for 6 months by using clinical and image methods and are examined the blood serum alpha-fetoprotein many times to make a definite diagnosis.The increased intensity of nodule can be divided into four types:high level echo, medium level echo,the low level echo and anechoic enhancement.It can give a definition of enhancement level and its change by taking a reference of meantime liver parenchyma enhancement level.Liver CEUS enhancement phases can be divided into the arterial phase(10～30s),portal phase(31～120s) and parenchymal phases(121～360s).The observation projects of lesion include enhancement starts and the duration,enhancement level(echo strength),take the highest part of echo level when the enhancement is not well-proportioned,enhancement way and the change of enhancement according to the phases developing(enhancement pours into pattern).ResultsThis research studies the united diagnoses of perfusion phase of real time grayscale contrast-enhanced ultrasound,enhanced peak value and extinctive time.In 26 cases of HCC which are under the condition of carrying out contrast-enhanced ultrasound,20 cases of them show high enhancement,low enhancement and low enhancement in arterial phase,portal phase and parenchymal phase respectively.4 cases show high enhancement,medium enhancement and low enhancement in these three phases respectively and 2 cases show medium enhancement in all of the three phases.In 26 cases of dysplastic nodule of liver cirrhosis which are under the same condition as HCC,15 cases of them show low enhancement,medium enhancement and high enhancement in arterial phase,portal phase and parenchymal phase respectively.7 cases show high enhancement,medium enhancement and medium enhancement and 1 case show high enhancement,medium enhancement and low enhancement in above three phases respectively.3cases show medium enhancement in all of the three phases.The enhanced peak value and extinctive period of small liver carcinoma are much earlier than dysplastic nodule of liver cirrhosis and the difference of the both sides has statistical significance(P＜0.05).Among the patients who suffered the small hepatoceUullar carcinoma,42.3 percent of them have the difficulty to be determined the nature or to be thought about the malignant ones before CEUS.After CEUS,according to the diagnostic standard which have no obvious enhancement in arterial phase,have no obvious withdrawal in parenchymal phase and have the difference of enhanced starting time,92.3 percent of the cases can be surely diagnosed the malignancy.The difference of diagnostic rate before-and-after CEUS has statistical significance(P＜0.05).Among the patients who suffered the dysplastic nodule of liver cirrhosis,57.7 percent of them are given a benign diagnosis or have the tendency to be benign before CEUS.After CEUS,according to the diagnostic standard which have no obvious enhancement in arterial phase,have no obvious withdrawal in parenchymal phase and have the difference of enhanced starting time,96.2 percent of the cases can be surely excluded from the malignancy.The difference of diagnostic rate before-and-after CEUS has statistical significance(P＜0.05).The perfusion characteristic of a mistaken case shows delayed enhancement in the later arterial phase and a little withdrawal in parenchymal phase(high enhancement,medium enhancement and low enhancement).Its enhanced peak value and extinctive period also displays a little early.The diagnosis of the case tends to be malignant and its pathological result by biopsy is dysplastic nodule of liver cirrhosis. ConclusionsContrast-enhanced ultrasound improves the diagnostic rate for establishment of primary liver carcinoma and dysplastic nodule of under the background of liver cirrhosis.The difference of CEUS enhancement mode,enhanced peak value and extinctive period can be distinguished and they may provide the exact dependable proof for the clinical early diagnosis and differential diagnosis.Contrast-enhanced ultrasound can be regarded as a effective method for the filtration of patients who suffered liver cirrhosis merged nodule.