title: Discrimination between neoplastic and non-neoplastic lesions in cirrhotic liver using contrast-enhanced ultrasound.
abstract: OBJECTIVE
  To assess the value of contrast-enhanced ultrasound (CEUS) in differentiating hepatocellular carcinoma (HCC) from non-neoplastic lesion in cirrhotic liver in comparison with baseline ultrasound.
  
  
  METHODS
  A total of 147 nodules (diameter ≤5.0 cm) in 133 cirrhotic patients (mean age±standard deviation: 52±13 years, range 20-82 years; gender: 111 males and 22 females) were examined with CEUS. There were 116 HCCs, 26 macroregenerative nodules and 5 high-grade dysplastic nodules. CEUS was performed with a real-time contrast-specific mode and a sulphur hexafluoride-filled microbubble contrast agent.
  
  
  RESULTS
  Hypervascularity was observed in 94.8% (110/116) HCCs, 3.8% (1/26) macroregenerative nodules and 60.0% (3/5) high-grade dysplastic nodules during arterial phase on CEUS. Detection rates of typical vascular pattern (i.e. hypervascularity during arterial phase and subsequent washout) in HCCs with a diameter of ≤2.0 cm, 2.1-3.0 cm and 3.1-5.0 cm were 69.2% (27/39), 97.1% (33/34) and 100.0% (43/43), respectively. CEUS significantly improved the sensitivity [88.8% (103/116) vs 37.1% (43/116), p<0.001], negative predictive value [70.5% (31/44) vs 31.5% (29/92), p<0.001], and accuracy [91.2% (134/147) vs 49.0% (72/147), p<0.001] in differentiating HCCs from non-neoplastic lesions when compared with baseline ultrasound. However, the sensitivity and accuracy of CEUS for HCCs ≤2.0 cm in diameter were significantly lower than those for HCCs of 2.1-3.0 cm and 3.1-5.0 cm in diameter.
  
  
  CONCLUSIONS
  CEUS improves diagnostic performance in differentiating HCCs from non-neoplastic nodules in cirrhotic patients compared with baseline ultrasound. Diagnosis of HCCs ≤2.0 cm diameter by CEUS is still a clinical concern, and thus needs further investigation.
authors.affiliation: Department of Medical Ultrasound, Medical Imaging Center, Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, Shanghai, China. xuhuixiong@hotmail.com
authors.forename: H-X
authors.initials: HX
authors.lastname: Xu
authors.forename: M-D
authors.initials: MD
authors.lastname: Lu
authors.forename: L-N
authors.initials: LN
authors.lastname: Liu
authors.forename: Y-F
authors.initials: YF
authors.lastname: Zhang
authors.forename: L-H
authors.initials: LH
authors.lastname: Guo
authors.forename: J-M
authors.initials: JM
authors.lastname: Xu
authors.forename: C
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D010743:Phospholipids; D011446:Prospective Studies; D013459:Sulfur Hexafluoride; D018608:Ultrasonography, Doppler; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride