Moudgil Sandeep, Kalra Naveen, Prabhakar Nidhi, Dhiman Radha Krishan, Behera Arunanshu, Chawla Yogesh Kumar, Khandelwal Niranjan
Department of Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Clin Exp Hepatol. 2017 Sep;7(3):222-229. doi: 10.1016/j.jceh.2017.03.003. Epub 2017 Mar 16.
BACKGROUND/AIMS: The most common primary malignant tumor of liver is hepatocellular carcinoma (HCC). The highest risk of developing HCC is seen in patients of cirrhosis. Ultrasound is used for surveillance in these patients. This study evaluates the role of contrast enhanced ultrasound (CEUS) in the diagnosis of HCC and compares CEUS to contrast enhanced computed tomography (CECT).
This prospective study included 22 patients with cirrhosis and suspected to have HCC on the basis of gray scale ultrasound or elevated Alpha-fetoprotein. Multiphasic CECT and CEUS were done. On both CECT and CEUS, arterial phase enhancement patterns of the lesions were classified as heterogeneously hyperenhancing, homogeneously hyperenhancing, isoenhancing or nonenhancing. The enhancement patterns of the lesions in portal venous phase were classified as hyperenhancing, isoenhancing, washout or nonenhancing. Presence or absence of neovascularity and peripheral capsule were also noted. The diagnosis of HCC was made as per American Association for the Study of Liver Diseases (AASLD) guidelines.
There was moderate degree of agreement between the two modalities in characterizing the enhancement pattern in arterial phase, as calculated by using kappa test ( = 0.59, < 0.05). Substantial agreement between them, for demonstrating the neovascularity, was also seen ( = 0.772, < 0.05). CEUS was found to be superior to CECT in demonstrating portal venous phase wash out and peripheral capsule. Only fair agreement was seen between them, with kappa value for portal venous washout being = 0.38 ( < 0.05) and for peripheral capsule being = 0.328 ( < 0.05).
CEUS is comparable to CECT in demonstrating the arterial phase enhancement pattern of HCC and the neovascularity. CEUS was found to be better than CECT in demonstrating the portal venous phase washout and peripheral capsule.
背景/目的：肝脏最常见的原发性恶性肿瘤是肝细胞癌（HCC）。肝硬化患者发生HCC的风险最高。超声用于这些患者的监测。本研究评估了超声造影（CEUS）在HCC诊断中的作用，并将CEUS与CT增强扫描（CECT）进行比较。
这项前瞻性研究纳入了22例肝硬化患者，这些患者基于灰阶超声或甲胎蛋白升高怀疑患有HCC。进行了多期CECT和CEUS检查。在CECT和CEUS上，病变的动脉期强化模式分为不均匀高增强、均匀高增强、等增强或无增强。门静脉期病变的强化模式分为高增强、等增强、廓清或无增强。还记录了有无新生血管和外周包膜。根据美国肝病研究协会（AASLD）指南进行HCC的诊断。
通过kappa检验计算，两种检查方法在动脉期强化模式特征方面存在中度一致性（κ = 0.59，P < 0.05）。在显示新生血管方面，两者也存在高度一致性（κ = 0.772，P < 0.05）。发现CEUS在显示门静脉期廓清和外周包膜方面优于CECT。两者之间仅存在一般一致性，门静脉期廓清的kappa值为κ = 0.38（P < 0.05），外周包膜的kappa值为κ = 0.328（P < 0.05）。
CEUS在显示HCC的动脉期强化模式和新生血管方面与CECT相当。CEUS在显示门静脉期廓清和外周包膜方面优于CECT。
