Contrast-enhanced ultrasound of hepatocarcinogenesis in liver cirrhosis

• Published in: Chinese medical journal 2012-09, Vol.125 (17), p.3104-3109
• Main Authors: Wu, Wei, Chen, Min-Hua, Sun, Maryellen, Yan, Kun, Yang, Wei, Li, Ji-You
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Contrast Media; Female; Humans; Image Enhancement; Liver Cirrhosis - complications; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Male; Middle Aged; Ultrasonography; 卡方检验; 增生性; 病理诊断; 肝癌; 肝硬化; 肝细胞癌; 超声; 造影
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.2012.17.025

Backoround Hepatocellular carcinoma （HCC） often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound （CEUS） and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard. Methods Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules （RNs）, dysplastic nodules （DNs）, or DNs with focus of HCC （DN-HCC）, were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns： type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase （washout）; type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）; and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）. The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test. Results Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows： type I, 49 （37.1%）; type II, 27 （20.5%）; type III, 28 （21.2%）; type IV, 9 （6.8%）; type V, 19 （14.4%）. Nodules with type I enhancement showed dysplasia in 5 （10.2%） cases; nodules with type II were dysplastic in 11 （40.7%） of cases; nodules with type III enhancement pattern were dysplastic in 22 （78.6%）, and those with type IV enhancement contained dysplasia in 7 （77.8%） of cases. Type V enhancement corresponded to DN-HCC in 19 （100%） of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis （Trend chi-square test, P 〈0.001）. Pathological diagnosis was HCC in the enhanced area and hepatocyte d