The Contrastive Study Of Conventional Ultrasound、the Contrast-enhanced Ultrasound And Acoustic Radiation Force Impulse Imaging In The Differential Diagnosis Of Benign And Malignant Liver Tumors

Background Liver tumor is one of the most common tumors in our country. Conventional ultrasound is often used to discover focal liver lesions, but it is limited in differentiating benign from malignant lesions. Both contrast-enhanced ultrasound(CEUS) and acoustic radiation force impulse imaging(ARFI) are newly developed techniques, and it was reported that they could be both well applied in differential diagnosis of benign and malignant liver tumors. But there were not any reports that have maken a contrastive study of conventional ultrasound, CEUS and ARFI in the differential diagnosis of benign and malignant liver tumors.Objective The aim of this study was to study the characteristics of conventional ultrasound, CEUS and ARFI in liver tumors, and to explore the clinical value of conventional ultrasound, CEUS and ARFI in differential diagnosis of benign and malignant liver tumors.Methods From March2009to July2011,156patients with170liver tumors(28hemangiomas,14focal nodular hyperplasias,16regenerating nodules,61hepatocellular carcinomas,39metastatic hepatic carcinomas,12cholangiocarcinomas) were included in the study. Each patient underwent conventional ultrasound, CEUS and ARFI respectively. And the two-dimension and color Doppler ultrasound images, CEUS images and the values of virtual touch tissue quantication(VTQ) of liver tumors were obtained. The analysis of benign and malignant liver tumors were performed by using conventional ultrasound, CEUS, ARFI in a double blind method. The accuracy of conventional ultrasound, CEUS and ARFI in the differential diagnosis of benign and malignant liver tumors were assessed by using pathology(needle biopsy/surgical operation) or computed tomography, magnetic resonance imaging, digital subtraction angiography as the gold standard.Results The sensitivity, specificity and accuracy in diagnosis of liver tumors with conventional ultrasound were57.14%,43.10%,52.35%, while of CEUS were92.86%,89.67%,91.76%, of ARFI were81.25%,74.14%,78.82%, respectively. There were statistical significance (P<0.05) between CEUS, ARFI and conventional ultrasound, CEUS and ARFI.Conclusions There is practical value of conventional ultrasound, CEUS and ARFI in the differential diagnosis of liver tumors. The differential diagnostic performance of CEUS and ARFI are better than conventional ultrasound, and CEUS is better than ARFI. Combined conventional ultrasound and CEUS with ARFI can improve the diagnostic performance, reduce the missed diagnosis and the misdiagnosis rate, and each method has complementary effect in the differential diagnosis of malignant and benign liver tumors.