Value of Perfusion Parameters for Differentiating Hepatocellular Carcinoma and Liver Metastasis With Hypervascularity and a Normal Hepatic Background on Contrast‐Enhanced Ultrasound Imaging

Abstract

Objectives-To retrospectively evaluate the value of contrast-enhanced ultrasound (CEUS) perfusion parameters in the differential diagnosis of hepatocellular carcinomas (HCCs) and metastatic liver tumors (MLTs) with hypervascularity.Methods-Sixty-seven HCCs and 55 MLTs with arterial homogeneous/heterogeneous hyperenhancement on CEUS imaging and a normal liver background were included in this retrospective study. Six CEUS perfusion parameters were compared between HCCs and MLTs with different sizes and HCC differentiations: rise time (RT), time to peak (TTP), mean transit time, wash-out time (WT), maximum intensity (IMAX), and area under the curve (AUC). The area under the receiver operating characteristic curve (AUROC) was determined to compare the diagnostic efficacy of the parameters.Results-The RT, TTP, and WT were significant longer and the IMAX and AUC were significantly higher in HCCs than in MLTs. In distinguishing between HCCs and MLTs, the AUROC was highest for the WT (0.922; sensitivity, 85.1%; specificity, 89.6%); the AUC and IMAX had the second and third highest AUROCs (AUC: 0.855; sensitivity, 76.1%; specificity, 80.6%; IMAX: 0.827; sensitivity, 76.1%; specificity, 77.6%). The AUROC was lowest for the TTP and RT (TTP: 0.719; sensitivity, 70.1%; specificity, 61.2%; RT: 0.707; sensitivity, 67.2%; specificity, 65.7%). In HCCs, both the tumor size and degree of differentiation affected the IMAX, AUC, and WT. In MLTs, perfusion parameters were not influenced by the tumor size.Conclusions-In HCCs and MLTs with hypervascularity and a normal liver background on CEUS imaging, various CEUS perfusion parameters, including IMAX, AUC, WT, RT, and TTP, differed significantly between tumor types. The WT may be the most useful parameter for differentiating between these tumors.

Diagnostic role of contrast-enhanced ultrasonography versus conventional B-mode ultrasonography in cirrhotic patients with early hepatocellular carcinoma: a retrospective study

“…Contrast-enhanced ultrasonography is an advanced B-ultrasonography examination tool. In China, the contrast agent used is SonoVue, a type of sulfur hexafluoride, which rarely leads to serious allergic reactions and adverse reactions and allows clearer imaging and more accurate diagnosis (17)(18)(19). Previous studies mostly showed that CEUS achieved about 70-90% sensitivity and about 80-100% specificity in the diagnosis of HCC (14,(20)(21)(22).…”

Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography

“…SNN with peripheral rim-like enhancement in the arterial phase should especially be distinguished from MHC. Previous studies had reported that when MHC lesions appeared to be necrotic, it could present peripheral rim-like enhancement in the arterial phase with the interior of the lesion showing no enhancement in the three phases [20][21][22]. However, there was a signi cant difference in the thickness of the enhancement ring in the arterial phase between MHC and SNN.…”

Imaging diagnosis of hepatocellular carcinoma: Future directions with special emphasis on hepatobiliary magnetic resonance imaging and contrast-enhanced ultrasound

“…CEUS can also offer quantitative features of dynamic contrast enhancement by analyzing the time-intensity curve, and it may be used for differentiating HCCs from other hepatic tumors [ 80 - 84 ]. One study comparing quantitative CEUS parameters between HCC and focal nodular hyperplasia reported that maximum intensity and rise slope were higher in focal nodular hyperplasia, while rise time and time-to-peak were higher in HCC [ 82 ].…”