Esposto Giorgio, Santini Paolo, Termite Fabrizio, Galasso Linda, Mignini Irene, Ainora Maria Elena, Gasbarrini Antonio, Zocco Maria Assunta
Department of CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Catholic University of Rome, Rome 00168, Italy.
Department of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
World J Gastrointest Oncol. 2024 Jun 15;16(6):2804-2815. doi: 10.4251/wjgo.v16.i6.2804.
Non-invasive differential diagnosis between hepatocellular carcinoma (HCC) and other liver cancer ( cholangiocarcinoma or metastasis) is highly challenging and definitive diagnosis still relies on histological exam. The patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical features. Dynamic contrast-enhanced ultrasound (DCEUS) with standardized software could help to overcome these obstacles, providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor perfusion.
To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver nodules.
A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological diagnosis. In accordance with the study protocol, a qualitative and quantitative analysis of the evidence was planned.
Rise time was significantly higher in HCC patients with a standardized mean difference (SMD) of 0.83 (95%CI: 0.48-1.18). Similarly, other statistically significant parameters were mean transit time local with a SMD of 0.73 (95%CI: 0.20-1.27), peak enhancement with a SMD of 0.37 (95%CI: 0.03-0.70), area wash-in area under the curve with a SMD of 0.47 (95%CI: 0.13-0.81), wash-out area under the curve with a SMD of 0.55 (95%CI: 0.21-0.89) and wash-in and wash-out area under the curve with SMD of 0.51 (95%CI: 0.17-0.85). SMD resulted not significant in fall time and wash-in rate, but the latter presented a trend towards greater values in HCC compared to intrahepatic cholangiocarcinoma.
DCEUS could improve non-invasive diagnosis of HCC, leading to less liver biopsy and early treatment. This quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.
肝细胞癌（HCC）与其他肝癌（胆管癌或转移瘤）之间的无创鉴别诊断极具挑战性，明确诊断仍依赖组织学检查。肝结节的强化和消退模式仅可用于对肝硬化患者的恶性风险进行分层，且HCC常表现出非典型特征。使用标准化软件的动态对比增强超声（DCEUS）有助于克服这些障碍，提供功能和定量参数，并可能提高肿瘤灌注评估的准确性。
探讨DCEUS在肝结节鉴别诊断中应用的临床证据。
对临床研究进行全面的文献检索，以确定可能与组织学诊断相关的DCEUS参数。根据研究方案，计划对证据进行定性和定量分析。
HCC患者的上升时间显著更高，标准化平均差（SMD）为0.83（95%CI：0.48 - 1.18）。同样，其他具有统计学意义的参数包括平均通过时间局部，SMD为0.73（95%CI：0.20 - 1.27），峰值强化，SMD为0.37（95%CI：0.03 - 0.70），曲线下洗入面积，SMD为0.47（95%CI：0.13 - 0.81），曲线下洗出面积，SMD为0.55（95%CI：0.21 - 0.89），以及曲线下洗入和洗出面积，SMD为0.51（95%CI：0.17 - 0.85）。SMD在下降时间和洗入率方面无显著差异，但与肝内胆管癌相比，后者在HCC中呈现出更高值的趋势。
DCEUS可改善HCC的无创诊断，减少肝脏活检并实现早期治疗。这种定量分析需要应用于更大的队列以证实这些初步结果。
