Contrast-enhancement Ultrasound Used In Small Hepatocellular Carcinoma And Microvascular Invasion

Objective To explore contrast-enhancement ultrasound(CEUS)parameters in different stage of small hepatocellular carcinoma(HCC).Methods CEUS data of pathologically proven small HCC in patients in hospital from July 2013 to September 2016 were collected in this retrospective study.Three groups were classified on the basis of Edmonson stage.Stage I,II 52 patients.Stage III 30 patients,stage IV 35 patients.Qontraxt Ultrasound Imaging Analysis Software was utilized to measure and calculate CEUS parameters,including the Maximum Intensity of Tumor(TMAX),Nontumour's intensity(NT),Maximum Intensity of Nontumor(NTMAX),calculate the value of TMAX:NT and TMAX:NTMAX and washout time.The difference between the three groups was compared by statistics test.Result The value of TMAX:NTMAX different among the stage I,II,stage III and stage IV were significant(0.98±0.18,1.15±0.07,1.29±0.14,P<0.001).The washout time different among the stage I,II,stage III and stage IV were significant(39.12±33.27,23.26±10.47,8.91±6.78,P<0.001).The value of TMAX different among the stage I,II,stage III and stage IV were significant(60.15±11.2,73.42±7.89,81.29±8.77,P<0.001).The disappear time different among the stage I,II,stage III and stage IV were significant(73.15±42.22,44.71±10.86,37.5±12.46,P<0.01).All above comparisons had significant differences among three groups.Conclusion: The CEUS enhancement parameters had significant difference between the different stages of small HCC.Object:Aim to investigate the correlation between contrast-enhanced ultrasonography and microvascular invasion in hepatocellular carcinoma.Methods: A total of 233 patients with hepatocellular carcinoma(HCC)confirmed by surgery or pathology were selected from our hospital in 2013.7-2016.9.According to the MVI,the patients were divided into MVI positive group(85 cases)and MVI negative group(n = 148).All cases were carried out contrast enhancement ultrasound(CEUS)examination before operation,utilize quantitative analysis software to analyze the imaging,including: tumor size,tumor shape,tumor area,and recorded area before and after CEUS,Maximum Intensity of Tumor(TMAX),Maximum Intensity of Nontumor(NTMAX),calculate the value of TMAX:NTMAX.Recordportal tumor regression rate,tumor washout time.Pathological grade.SPSS analysis of the various factors,and single factor analysis of significant differences in variables,included in the multivariate analysis.Among them,P<0.05 was considered as significant differences.Results:The diameter of tumor in MVI positive group were larger than MVI negative group(4.16 + 1.65 VS 3.66 + 1.36,P=0.02);The irregular shape proportion in MVI positive group were higher than MVI negative group(64.7% VS 48%,P=0.014);The area variance of tumor before and after CEUS were higher in MVI positive group than MVI negative group(3.67 + 2.54 VS 2.01 + 1.51,P=0.001);The portal phase fast washout rate in MVI positive groupwere higher than MVI negative group(62.4% VS 35.8%,P=0.001);The washout time in MVI positive group is shorter than the MVI negative group(16.44 + 15.24 VS 21.26 + 16.12,P=0.024);The poorly differentiated and undifferentiated proportion in MVI positive group is higher than MVI negative group(63.5% VS 38.5% P=0.001).There is no significant differences in the constituent ratio AFP,the Maximum Intensity of Tumor(TMAX),Maximum Intensity of Nontumor(NTMAX),the TMAX:NTMAXratio,the number of tumor between the two group.single factor analysis of significant differences in variables,included in the multivariate analysis,the results showed portal phase fast washout rate,area variance of tumor before and after CEUS and tumor size were statistically significant,can be used as an independent predictor of MVI,the OR values were 0.30,3.78,0.27 respective,and drawing the ROC curve.The area under the ROC curve was 0.826(95%CI 0.777-0.884).Utilize 2.195 as area variance of tumor before and after CEUS dividing value to predict MVI,the specificity was 0.682,the specificity was 0.696,the positive predictive value was 67.92%,and the negative predictive value was 72.78%.Conclusion:Quantitative analysis in CEUS play an important role in predicting the MVI,the variance of tumor before and after CEUS,fast regression and larger diameter(>3.7cm)can be used as an independent predictor of MVI,when the maximum tumor diameter larger than 3.7cm,area variance of tumor before and after CEUS more than 2.195,and fast regression in the portal phase,should be highly suspected the existence of MVI.