Comparative Study Of CEUS And CECT In The Diagnosis Of Liver Cancer Lesion Size

ObJective:To investigate the diagnostic value of Contrast enhanced ultrasound(CEUS)and Contrast enhanced X-ray computed tomography(CECT)in the diagnosis of Hepatocellular carcinoma with different tumor sizes.It aims to explore two kinds of imaging methods the accuracy of diagnosis of cancer tumor size,and thus provide some guidance for clinical treatment.Clinical data:Retrospective analysis of June 2013 to June 2016 in our hospital were treated by surgical resection of specimens by histopathologically confirmed liver cancer patients197 cases(all patients with lesions were single lesions,preoperative CEUS and CECT examination).Including 104 males and 93 females,aged 22 to 70 years,the median age of 52 years old.Tumor surgical specimens measuring the maximum diameter of 1.0 ~8.0cm,the average maximum diameter(4.0 ± 2.2)cm.CEUS and CECT check the time difference of not more than 7 days,two kinds of imaging methods from the pathological examination of the time are not more than 21 days.The group A of 96 cases of liver cancer,liver cancer in group B and C 101 cases,of which the maximum tumor diameter<3.0cm 63 cases,the maximum diameter> 5.0cm 38 cases.Apparatus and method:Color ultrasound diagnostic instrument is used in Philips iU22 color Doppler ultrasound diagnostic apparatus.The convex array probe has a frequency of 2.5 to 5.0MHz.With contrast pulse sequence(CPS)CEUS imaging technology and real-timeharmonic imaging technology(MI).Or the use of Siemens Acuson Sequoia512 color Doppler ultrasound diagnostic apparatus,convex array probe.The convex array probe has a frequency of 1.0-4.0MHz,and has CPS CEUS imaging technology.Selection of an ultrasound contrast agent is sulfur hexafluoride microbubbles(SonoVue).CECT using GE's VCT 64-row spiral scanner.Contrast agent selection of iodixanol.CEUS: check the patient before the fasting of water for more than 8h,first routine color Doppler ultrasonography probe liver parenchyma,and then determine the lesion and observe the location of the lesion location,size,shape,boundaries,and then fixed ultrasound probe.And then use a syringe to extract 0.9% sodium chloride solution 5ml dissolved contrast agent freeze-dried powder.Shock after mixing with a syringe to extract 2.4ml,through the group injection method quickly into the elbow vein.And rinsed with 5 ml of 0.9% sodium chloride solution.At the same time as the contrast agent was injected,the built-in timer and built-in video recording of the color ultrasonic diagnostic instrument were started under the contrast mode.The whole process of lesion angiography was observed in real time(6 min),and the images were analyzed frame by frame.Contrast diagnosis results by two senior doctors with ultrasound examination of common reading,and then get the lesion border and location.First make a qualitative diagnosis,and then make the diagnosis of the size of the lesion(if the difference between the two diagnostic results,then ask the chief physician to read the analysis and make a diagnosis).The whole process of CEUS in the liver can be divided into three phases: arterial phase(0 ~ 30s),portal vein phase(31 ~ 120 s),delayed phase(121 ~360 s).CECT: Check the patient before the fasting for more than 8h.First on the abdomen after the scan,and then enhanced scan,three times to obtain the scanned image.Enhance the diagnosis of the results by two doctors to complete the analysis(if the difference between the two diagnostic results,then ask the chief physician to read the analysis and make a diagnosis).Result:1.Pathological and histological diagnosis of 197 cases of liver cancer lesions,including primary liver cancer in 183 cases(182 cases of hepatocellular carcinoma),intrahepatic cholangiocarcinoma in 3 cases,secondary to liver cancer in 12 cases.Group A: 95 cases of primary liver cancer(95 cases of hepatocellular carcinoma),1 case of secondary liver cancer;Group B: 54 cases of primary liver cancer(54 cases of hepatocellular carcinoma),9 cases of secondary liver cancer;C: 33 cases of primary liver cancer(33 cases of hepatocellular carcinoma)3 cases of cholangiocarcinoma,2case of secondary liver cancer.1.1 Foundation history Group A: 95 cases of hepatocellular carcinoma lesions,combined with hepatitis history of 89 cases(liver cirrhosis in 63 cases),combined with fatty liver disease in 5 cases,1 case without any basic medical history;1 case of secondary liver cancer lesions with chronic atrophic gastritis history(Pathology prompted the primary tumor from the stomach).Group B: 54 cases of primary liver cancer lesions,combined with 50 cases of hepatitis history(hepatitis cirrhosis in48cases),combined with fatty liver disease in 2 cases,2 cases without any basic history;9 cases of secondary liver cancer lesions,which combined Chronic atrophic gastritis history of 9 cases(pathology prompted pathology prompted 5 cases of primary lesions from the stomach,4 cases of primary lesions from the colon);group C: 37 cases of primary liver cancer lesions,combined with liver disease history of 33 cases(hepatitis Liver cirrhosis in 31 cases),1 case without any basic medical history;1 case of 15 years after radical resection of colon cancer(pathology prompted the primary tumor from the colon).1.2 Enhancement of liver cancer lesions and measurement In this study,the primary hepatocellular carcinoma lesion CEUS showed "fast forward and fast" performance,that is,the arterial phase of the overall spherical rapid enhancement and portal phase in advance clearance(compared with the same period of liver parenchyma);Metastatic liver cancer lesions CEUS showed "fast forward faster" performance,that is,the whole arterial phase was dendritic rapid enhancement and portal phase in advance to clarify.Primary liver cancer lesions CECT most of the "fast forward" performance,that is,high arterial phase enhancement and portal phase enhancement and delayed low enhancement,a small number of imaging "fast forward and slow out" performance,that is,arterial phase and portal Period enhancement,delay period phase enhancement.Metastatic liver lesions CECT presented "fast-forward quicker out" performance.CEUS and CECT measurement of lesion size,every doctor's diagnosis were three image analysis is completed,the lesions clear boundary,the largest lesion diameter of the largest cross-sectional image as measured.2.The area under the working characteristic(ROC)curve of 197 patients with liver cancer lesion size was 0.774 and 0.706,respectively.There was no significant difference between the two groups(P> 0.05).3.The specificity of CEUS was 80.6%-85.8%,the sensitivity was 73.2%-91.6%,the specificity of CECT was 65.1%-77.2%,and the sensitivity was 63.2%-85.3%.The accuracy of CEUS and CECT was 97.9%(94/96)and 89.6%(86/96)respectively.The difference between the two methods was statistically significant(P <0.05).Group B:CEUS and CECT(P <0.05).The accuracy of the two methods was 90.4%(57/63)and87.3%(55/63),respectively.There was no significant difference between the two methods(P> 0.05)94.7%(36/38)and 97.3%(37/38),respectively.There was no significant difference between the two methods(P> 0.05).Conclusions:CEUS and CECT have a great clinical value in the measurement of hepatocellular carcinoma lesion size.However,the CEUS examination has a higher application for the measurement of hepatocellular carcinoma size in view of the guidance of clinical preoperative operation and the patients themselves.