| Focal liver lesions (FLLs) include various kinds of hepatic benign or malignant tumors or tumor-like diseases. Malignant lesions include hepato-cellular carcinoma (HCC), metastatic liver carcinoma (MLC) and intrahepatic cholangiocarcinoma (ICC) etc. Hepatic hemangioma is the most common in all kinds of benign lesions, and inflammatory pseudotumor (IPT), hepatapostema and focal fatty change (FFC) are often detected in hospital.In our country, HCC has high rate in digestive systematic malignant tumors, and liver is the frequent metastatic organ of other organ tumors. So giving diagnosis and therapy earlier is the key of improving prognosis and survival rate. As we all know that hemangioma and IPT are benign tumors of liver and the growth is slow, they are harmless to the human body. Therefore, the identification of benign or malignant tumors is very important. It has vital clinical significance for treatment and prognosis.Determining the nature of FLLs is essential in clinical procedures. At present, giving diagnosis of FLLs is mainly made by imaging modalities, including ultrasound, CT and MRI. These imaging modalities not only can display the site of FLLs but also play an important role on identification of benign or malignant of FLLs. CT and MRI can display the site of FLLs and even can make relatively precise diagnosis, but they are too expensive and radioactive to becoming conventional imaging procedure.Because of being noninvasive, convenient and economic, conventional ultrasound becomes the preferred imaging method. As the lesion is bigger and its distinction is obvious, it is easy to diagnosis. Yet as the lesion is smaller, and clinical physical signs and laboratory examinations are not certain, sonogram changes are not easy to distinct, and it is difficult to make correct diagnosis. The application of color Doppler ultrasonography on diagnose of liver lesions provides valuable information for the diagnosis and identification of liver tumors at the point of blood supply and blood dynamics. But it is insensitive for the blood hypo-supply, deep location of tumors, the tiny vas and slow blood flow etc. As the rapid development of the modern contrast agent and the technology, contrast-enhanced ultrasonography (CEUS) is revolutionary development and the historical revolution for ultrasonography. As the representative of the newest generation modern ultrasonic contrast agent, SonoVue is used extensively in clinical. CEUS can show the blood perfusion of the liver tumors on the real-timed; especially it can provide more information about the detection of tiny vas, perfuse physiology of microcirculation and perfuse pathology of microcirculation. So we can improve the capability of qualitative diagnose on tumors through the characteristic of blood supply of different tumors. In addition, CEUS has more advantage in evaluating liver interventional therapy response:no radiation, observing therapy response intraoperation and the short term repeatedly to reduce the suffering of the patients.At present, domestic and foreign researchers conduct a lot of research and access many valuable achievements and experience in the diagnosis and differential diagnosis of focal liver lesions using the method of CEUS. But the research on unrepresentative CEUS of malignant tumor and CEUS of benign FLLs with lower incidence is not enough. For the reasons mentioned above, this dissertation analyzed result of 120 examples FLLs of CEUS, and did penetrating approach on the value of CEUS in diagnosis of FLLs so that accumulating more experience and data.One hundred and twenty examples were prospectively evaluated with CEUS. All the examples were authenticated by operations or pathology puncture, or confirmed by the combination of CT/MRI and clinic materials. The clinical result Includes:28 hepatocellular carcinoma (HCC),26 metastatic liver carcinoma(MLC),3 intrahepatic cholangiocarcinoma(ICC),34 hepatic hemangioma,15 inflammatory pseudotumor(IPT),5 hepatapostema,3 focal fatty change (FFC)and 6 hepatic carcinoma with interventional therapy:2 were recurring and 4 were deactivation. Enhancement patterns of 120 of FLLs:(1) HCC:22(78.6%) were "fast-in and fast-out".6(22.4%) were "fast-in and slow-out". (2) MLC:19(73%) were "fast-in and fast-out".7(23%) were "slow-in and slow-out". ALL of 19 MLC were hypo-enhance in late phase. (3) ICC:3(100%) were "fast-in and fast-out". (4) Hepatic hemangioma:Enhancement morphology in arterial phase was ring with peripheral enhancement or non-enhancement, sequentially nodular enhancement to center slowly.25(73.5%) were "fast-in and slow-out".9(26.5%) were "slow-in and slow-out". (5) IPT:15(100%) were non-enhancement nodule. (6) Hepatapostema:4(75%) presented honeycomb-like enhancement, and internal septation enhanced in coincidence with liver tissue.1(25%) CEUS presented non-enhancement in every phase. (7) FFC:3 (100%) enhanced in coincidence with liver tissue. (8) This dissertation followed up 6 patients suffering live carcinoma with interventional therapy:4 were deactivation and presented non-enhancement.2 were recurring and presented "fast-in and fast-out".Compared to conventional ultrasound, in differentiation of benign and malignant focal liver lesions, the sensitivity, specialty, accuracy rate, positive predictive value and negative predictive value of CEUS were improved obviously. The sensivity improved 27.1%, the specialty improved 26.2%, the accuracy rate improved 26.7%, the positive predictive value improved 28.1% and negative predictive value improved 25.4%。The result of the study shows that:Major of HCC present "fast-in and fast-out", this is the typical character of HCC. Enhancement pattern of CEUS maybe reflect indirectly the differentiation degree of malignant tumors. More malignant and more poorly differentiated, the enhancement pattern presented "fast-in and fast-out".MLC has all kinds of appearance of CEUS, which is decided by blood supply in lesions. Plentiful blood supply in lesions maybe present "fast-in and fast-out". Oppositely, CEUS maybe presented "slow-in and slow-out". And CEUS could improve the sensitivity of finding tiny lesions and improve the detection rate of FLLs.Major of hepatic hemangioma presented nodular enhancement to center slowly. This is the character of the hepatic hemangloma. Other benign FLLs presented "synchronism-in and synchronism-out" or "non-in and non-out".CEUS has important significance for the interventional therapy of tumors. It can be a useful and effective technique for evaluating the interventional therapeutic effects. When the tumor is necrotic completely, CEUS will present non-enhancement in every phase; when the tumor is not necrotic completely or is recurring, CEUS will present "fast-in and fast-out".The application of CEUS improves enormously capability of giving diagnosis of FLLs. The diagnostic effect of CEUS is the same as contrast-enhanced CT and contrast-enhanced MRI. And CEUS has better temporal resolution, this will surpass contrast-enhanced CT and contrast-enhanced MRI. Not only CEUS can improve obviously the diagnostic rate of FLLs, but also it is convenient, safe, and economic, and will become a broad prospect of imaging diagnosis.
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