Comparison Of Enhancement Features Of The Dysplastic Nodule And The Small Hepatocellullar Carcinoma In Patients With Liver Cirrhosis On Contrast-enhanced Ultrasonography

Objective:To investigate the perfusion and enhancement pattern of the dysplastic nodule (DN) of liver cirrhosis and the small hepatocellullar carcinoma (SHCC) by contrast-enhanced ultrasound (CEUS), with QontraXt quantitative analysis software, and to discuss the diagnostic value of CEUS in two types of lesions.Methods:Thirty-four cases of liver cirrhosis space occupying and small nodule with38lesions were examined by CEUS, the contrast-enhanced ultrasound dynamic images were stored at the same time.Among these cases,18cases with20lesions were diagnosed SHCC,16cases with18lesions were diagnosed DN eventually.We analysed the enhancement of the two types of lesions from three aspects,including phase、shape and pattern of enhancement,and drawed the time-intensity curve (TIC) with QontraXt software.The curve offered the perfusion parameters: the begin time,the time to peak,the peak of the signal intensity,the sharpness of time-intensity curve,the area under the curve. Summarized dysplastic nodule of liver cirrhosis and small hepatocellullar carcinoma perfusion characteristics and difference.All the nodules were confirmed by surgery or ultrasound-guided biopsy for pathologic diagnosis results and clinical follow-up.Results:①The sensitivity,specificity and accuracy respectively were60.0%、50.0%、55.3%in conventional US and100.0%、83.3.0%、92.0%in CEUS(P<0.05).②Most SHCC showed hyper-enhancement during the arterial phase,iso-enhancement or hypo-enhancement during the portal phase,hypo-enhancement during the late phase.The enhanced phase and degree of the dysplastic nodule of liver cirrhosis was diverse,mostly iso-enhancement during the three phases.The enhanced phase of them has significant difference(P<0.05).③Most SHCC and DN showed homogeneous enhancement.The enhancement shape of the dysplastic nodule of liver cirrhosis and the small hepatocellullar carcinoma has no significant difference(P>0.05).④Of20SHCC lesions,11leisions had a contrast-enhancement pattern of "fast-in and slow-out",9leisions were "fast-in and fast-out";among18DN leisions,1leision enhanced during the portal phase and the late phase,it didn’t enhanced during the arterial phase,3leisions started to enhanced at the late arterial phase,14leisions were iso-enhancement during the three phases.⑤The begin time and the time to peak in the SHCC was shorter than that of the adjacent liver cirrhosis parenchyma, the sharpness of time-intensity curve and the peak of the signal intensity were higher than that of the adjacent liver cirrhosis parenchyma,and the difference has statistical significance (P<0.05).Comparison of parameters of the dysplastic nodule of liver cirrhosis and the adjacent liver cirrhosis parenchyma,they have no significant difference(P>0.05).Compared with DN, the begin time and the time to peak in the SHCC was shorter, the sharpness of time-intensity curve was sharper,the peak of the signal intensity was higher,and the difference has statistical significance(P<0.05)Conclusions:Contrast-enhanced ultrasound can provide important differential diagnosis in the dysplastic nodule of liver cirrhosis and the small hepatocellullar carcinoma.