Assessment Of The Pathological Differentiation Of Focal Liver Lesions Using Washout Features In Contrast-enhanced Ultrasound

Objective:To analyze the washout features of different focal liver lesions in contrast-enhanced ultrasound and to explore its value in clinical diagnosis.Methods:Analysis of 404 cases of focal nodules diagnosed by our hospital from 2016 to 2018,including 167 benign nodules,92 hepatic hemangioma,39 FNH,36 liver abscesses,237 malignant nodules,and 103 HCC(including 31 highly differentiated,29 moderately differentiated,43 poorly differentiated,diameter ? 3cm65,diameter > 3cm38),25 ICC,109 MHC.237 malignant nodules were confirmed by pathology.21 of 167 benign nodules were confirmed by pathology,and 146 were diagnosed by contrast-enhanced ultrasound and CT-enhanced or MRI-enhanced examination.The time-intensity curve of contrast-enhanced ultrasound was drawn with the software built in the ultrasound diagnostic apparatus.The quantitative parameters of focal nodules of different livers were analyzed and summarized: the initial elimination time,the peak halving time and the descending branch slope.Measurement data are expressed as mean ± standard deviation(`x±s).Measurement data were compared using t test.Two or more sets of measurement data were tested by ANOVA,and two of them were compared using the LSD method.The difference was statistically significant at P < 0.05.ROC curve analysis is used to evaluate and determine thresholds for diagnostic indicators.Results:The time of onset and peak halving of benign focal nodules in liver was later than malignant nodules,and the difference was statistically significant(P<0.05).The slope of the descending branch of the malignant focal nodule of the liver was greater than that of the benign focal nodule.The difference was statistically significant(P<0.001).2.The time of liver abscess disappeared and the peak halved time was earlier than hepatic hemangioma and focal nodular hyperplasia of the liver.The descending branch slope was greater than hepatic hemangioma and focal nodular hyperplasia of the liver.The difference was statistically significant(P<0.001).3.109 cases of metastatic hepatocellular carcinoma began to regress and the peak halved time was earlier than the primary one.Liver cancer(P<0.05),the descending branch slope was greater than that of primary liver cancer(P<0.05).4.103 HCC small and medium liver cancer peak halving time was later than non-small liver cancer,the difference between the initial regression time and the descending branch slope was not statistically significant.Significance(P>0.05).5.The peak halving time of poorly differentiated HCC was significantly earlier than that of moderate or highly differentiated HCC(P<0.05).There was no significant difference in the time of regression and the slope of descending branch of different differentiation degrees(P>0.05).Taking the peak halving time as the ROC curve for judging the well-differentiated,moderately differentiated and poorly differentiated HCC,according to the Yoden index,HTD?55.49 s was used as the diagnostic reference value for poorly differentiated liver cancer,and its sensitivity and specificity were 95.7%,respectively.73.9%.Conclusion:1.Some liver benign focal nodules and malignant focal nodules have distinct features.The contrast-enhanced features of liver abscess were similar to those of malignant focal nodules,and some were low in the portal phase.2.most of the metastatic liver cancer began to resolve in the late arterial or portal phase,significantly earlier than the primary liver cancer,and the clearance rate is faster than the primary liver cancer,showing a low enhancement in the delayed period,called "black hole."3.The clearing characteristics of hepatocellular carcinoma are related to the size.The peak of small liver cancer is halved later than non-small liver cancer,and the clearance speed is faster.4.The clearing characteristics of hepatocellular carcinoma are related to the degree of differentiation.The lower the degree of differentiation of hepatocellular carcinoma,the halved peak time is earlier than the hepatocellular carcinoma with high degree of differentiation.According to the ROC curve,the peak halving time is ?55.49 s as poorly differentiated liver cancer.Diagnostic reference value.