title: [Early diagnosis of small hepatocellular carcinoma by new contrast-enhanced ultrasound technique].
abstract: OBJECTIVE
  To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) enhancement patterns of hepatocellular carcinoma (HCC) smaller than 2 cm.
  
  
  METHODS
  From 392 cases with focal liver lesions undergoing CEUS with SonoVue and Contrast Tuned Imaging (CnTI) technique, thirty six cirrhotic patients with thirty eight HCCs with histopathological diagnosis were retrospectively analyzed in this study. Surgery or needle biopsy was performed within fifteen days after CEUS. Twenty two tumors were finally diagnosed as moderately differentiated HCC, twelve as well differentiated HCC, and four as clear cell carcinomas using Edmondson Grade system. The enhancement patterns of different histopathological HCCs were analyzed.
  
  
  RESULTS
  Before CEUS, only 16 lesions (42.1%) were diagnosed as malignant or possibly malignant. After CEUS, 38 HCCs were enhanced in different degrees following contrast administration,of which, all the 22 moderately differentiated HCCs presented typical "fast-in and fast-out" pattern with fast enhancement in arterial phase and then a quick wash-out in the parenchymal phase. Nine (75.0%) of the 12 well differentiated HCCs presented "fast-in and slow-out" pattern. One of the 4 clear cell carcinomas presented "fast-in and fast-out", one presented "fast-in and slow-out" and the other 2 presented "slightly slow-in and slow-out" pattern. According to the enhancement patterns, 76.3% (29 tumors) were considered as malignant, while 18.4% (7 tumors) as possibly malignant, only 5.3% (2 tumors smaller than 1.5 cm) could not be diagnosed by CEUS.
  
  
  CONCLUSIONS
  The identification of different enhancement patterns of various histological types of small HCCs could improve the diagnostic ability of ultrasound in cirrhotic liver. CEUS might be also helpful in detecting small HCCs. Thus CEUS could be a complementary method of enhanced CT and other imaging methods in early diagnosis of HCCs.
authors.affiliation: Department of Ultrasound, Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100036, China. minhuachen@vip.sina.com
authors.forename: Min-hua
authors.initials: MH
authors.lastname: Chen
authors.forename: Ying
authors.initials: Y
authors.lastname: Dai
authors.forename: Kun
authors.initials: K
authors.lastname: Yan
authors.forename: Zhi-hui
authors.initials: ZH
authors.lastname: Fan
authors.forename: Wei
authors.initials: W
authors.lastname: Wu
authors.forename: Yan-bin
authors.initials: YB
authors.lastname: Wang
authors.forename: Shan-shan
authors.initials: SS
authors.lastname: Yin
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Ji-you
authors.initials: JY
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media