Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China.
J Ultrasound Med. 2023 Dec;42(12):2825-2838. doi: 10.1002/jum.16321. Epub 2023 Sep 15.
To compare the on-site diagnostic performance of contrast-enhanced ultrasound (CEUS), computed tomography (CECT), and magnetic resonance imaging (CEMRI) for hepatocellular carcinoma (HCC) across diverse practice settings.
Between May 2019 and April 2022, a total of 2085 patients with 2320 pathologically confirmed focal liver lesions (FLLs) were enrolled. Imaging reports were compared with results from pathology analysis. Diagnostic performance was analyzed in defined size, high-risk factors for HCC, and hospital volume categories.
Three images achieved similar diagnostic performance in classifying HCC from 16 types of FLLs, including HCC ≤2.0 cm. For HCC diagnosis at low-volume hospitals and HCC with high-risk factors, the accuracy and specificity of CEUS were comparable to CECT and CEMRI, while the sensitivity of CEUS (77.4 and 89.5%, respectively) was inferior to CEMRI (87.0 and 92.8%, respectively). The diagnostic accuracy of CEUS + CEMRI and CEUS + CECT increased by 7.8 and 6.2% for HCC ≤2.0 cm, 8.0 and 5.0% for HCC with high-risk factors, and 7.4 and 5.5% for HCC at low-volume hospitals, respectively, compared with CEMRI/CECT alone.
Compared with CECT and CEMRI, CEUS provides adequate diagnostic performance in clinical first-line applications at high-volume hospitals. Moreover, a higher diagnostic performance for HCC is achieved by combining CEUS with CECT/CEMRI compared with any single imaging technique.
比较对比增强超声（CEUS）、计算机断层扫描（CECT）和磁共振成像（CEMRI）在不同实践环境下对肝细胞癌（HCC）的现场诊断性能。
2019 年 5 月至 2022 年 4 月，共纳入 2085 例 2320 例经病理证实的局灶性肝病变（FLL）患者。将影像学报告与病理分析结果进行比较。在定义的大小、HCC 的高危因素和医院容量类别中分析诊断性能。
三种图像在将 HCC 从 16 种 FLL 中分类方面表现出相似的诊断性能，包括 HCC≤2.0cm。对于低容量医院的 HCC 和具有高危因素的 HCC，CEUS 的准确性和特异性与 CECT 和 CEMRI 相当，而 CEUS 的敏感性（分别为 77.4%和 89.5%）低于 CEMRI（分别为 87.0%和 92.8%）。对于 HCC≤2.0cm、HCC 具有高危因素和 HCC 低容量医院，CEUS+CEMRI 和 CEUS+CECT 的诊断准确性分别比 CEMRI/CECT 单独使用提高了 7.8%和 6.2%、8.0%和 5.0%以及 7.4%和 5.5%。
与 CECT 和 CEMRI 相比，CEUS 在大容量医院的临床一线应用中提供了足够的诊断性能。此外，与任何单一成像技术相比，CEUS 与 CECT/CEMRI 相结合可实现更高的 HCC 诊断性能。
