Contrast Enhanced Ultrasonography In Diagnosis Of Postoperative Intrahepatic Recurrence Of Hepatocellular Carcinoma

[Objective] To observe the expression of contrast-enhanced ultrasonography (CEUS) in characterization of recurrent hepatocelluar carcinoma(RHCC), and evaluate the value of CEUS in detection rate and diagnositc accuracy rate of intrahepatic recurrence(≤3.0cm), discuss the clinical value of low mechanical index CEUS in monitoring intrahepatic recurrence.[Methods] Collected the clinical follow-up data of patients who underwent hepatice resection for HCC at department of hepatic surgery, which affiliated provincial hospital of Anhui medical university, between June,2008and October,2011. All patients were treated with conventional ultrasound, contrast-enhanced computed tomography(CECT) and serum alpha-fetoprotein (AFP) during the follow-up period, when conventional ultrasound findings of new liver lesions, CEUS must be used at the same time, the imaging features of different lesions were record and analyzed. The diagnosis results of CEUS were calculated by postoperative pathology or needle biopsy results as the reference standards, summed up the enhancement level, enhancement morphology and enhancement pattern of RHCC. Compare the detection rate and diagnositc accuracy rate of intrahepatic recurrence(≤3.0cm), which underwent CEUS and CECT, assessment the clinical value of CEUS in early diagnosis of recurrence.[Results] New lesions occurred in39HCC patients in followed up, for a total of50(less than3.0cm in diameter). Finally,46recurrence lessions in35patients were diagnosed for RHCC by postoperative pathology or needle biopsy results as the reference standards. Another4patients with4lesions were diagnosed for dysplastic nodule by using clinical and image methods for more than6months follow-up. The type of enhancement pattern for RHCC were "fast-in and fast-out","fast-in and slow-out" and "solw-in and fast-out", and90.7percent of RHCC expressed as "fast-in and fast-out". The enhancement morphology of RHCC including overall enhancement, peripheral enhancement and dotted enhancement, and69.8percent of them were overall enhancement. Forty-six recurrence lessions in35patients were diagnosed,43recurrence lessions were detected by CEUS and42recurrence lessions were detected by CECT. the detection rate of intrahepatic recurrence was93.5%for CEUS and91.3%for CECT, respectively. Taking hypervascular during arterial phase and washout during pertal or late phase as the diagnostic criteria, diagnositc accuracy rate was84.8%(39/46) for CEUS and80.4%(37/46) for CECT, respectively. There has no significance between CEUS and CECT (F>0.05). Among nine lessions, which four of them were not detected and five diagnosed uncertain on CECT, while eight of them were diagnosed definitely by CEUS.[Conclusions] The typical characteristics of RHCC was "fast-in and fast-out", which the lession expressed hypervascular during arterial phase and hypoechdic during pertal or late phase. CEUS show similar value in detection rate and diagnositc accuracy rate of intrahepatic recurrence(≤3.0cm) with CECT. CEUS has additional diagnostic value to lessions which is atypical or undetected on CECT, and can be used as imaging methods for monitoring intrahepatic recurrence.