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目的探讨超声造影(CEUS)对肝硬化背景下早期HCC的诊断效能,通过分析早期HCC增强特征,提高CEUS对早期HCC与增生结节的鉴别诊断能力。方法接受CEUS检查的肝硬化患者2 130例,176例满足入选标准。以超声引导穿刺活检病理诊断作为金标准,通过ROC曲线回顾性分析CEUS对不同直径分层下HCC的诊断效能,并对早期HCC与增生结节的CEUS增强模式进行对比分析。结果 176例患者176个结节中HCC 127个,良性结节49个。85.8%(109/127)HCC结节在CEUS上表现为动脉期高增强,1~2cm组和2~3cm组中的81.0%和90.0%的HCC结节动脉期表现为高增强。1~2cm组和2~3cm组中HCC表现为典型增强模式的结节分别为72.4%和88.4%(P=0.022)。58个1~2cm组HCC,16个结节不符合指南推荐典型HCC的CEUS增强模式。结论 CEUS对肝硬化背景下HCC早期诊断及与各类增生结节的鉴别诊断具有较高的诊断效能;与直径2~3cm的HCC相比,直径1~2cm的HCC表现为典型增强模式的比例降低,应高度警惕;动脉期高增强表现对早期HCC诊断具有重要价值,但应注意与动脉期高增强的增生不良结节进行鉴别。
Objective To investigate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) in the diagnosis of early-stage HCC in cirrhotic cirrhosis and to improve the differential diagnosis between early-stage HCC and proliferative nodules by analyzing the enhancement characteristics of early stage HCC. Methods Two hundred and seventy patients with cirrhosis undergoing CEUS were examined, and 176 patients met the inclusion criteria. The pathological diagnosis of ultrasound-guided biopsy was taken as the gold standard. The diagnostic efficiency of CEUS for HCC with different diameter stratification was retrospectively analyzed by ROC curve, and CEUS enhanced mode of early HCC and hyperplastic nodules were compared. Results Among the 176 patients, there were 127 HCCs and 176 benign nodules in 176 nodules. 85.8% (109/127) of HCC nodules showed high enhancement of arterial phase on CEUS, and 81.0% and 90.0% of HCC nodules in 1 ~ 2 cm and 2 ~ 3 cm groups showed high enhancement in arterial phase. The nodules with typical enhancement patterns of HCC in 1 ~ 2 cm and 2 ~ 3 cm groups were 72.4% and 88.4%, respectively (P = 0.022). Fifty-eight 1 to 2 cm HCCs and 16 nodules did not meet the CEUS enhancement pattern recommended by the guidelines for typical HCCs. Conclusions CEUS has high diagnostic value for early diagnosis of HCC in cirrhosis and differential diagnosis of various types of hyperplastic nodules. Compared with HCC of 2 ~ 3cm in diameter, HCC with diameter of 1 ~ 2cm showed a typical ratio of enhancement mode Reduce, should be highly vigilant; high performance of arterial phase of early diagnosis of HCC has important value, but should pay attention to high proliferation and poor arterial phase nodules were identified.