Parametric imaging with contrast-enhanced ultrasound for differentiating hepatocellular carcinoma from metastatic liver cancer.
OBJECTIVE
To evaluate the diagnostic performance of parametric imaging with contrast-enhanced ultrasound(CEUS) for differentiating hepatocellular carcinoma(HCC) from metastatic liver cancer(MLC).


METHODS
30 HCCs (mean diameter, 3.6±1.3 cm; range, 2.1-5.0 cm) and 30 MLCs (mean diameter, 2.8±1.5 cm; range, 1.2-5.0 cm) pathologically diagnosed or confirmed by clinical criteria that underwent CEUS were randomly included. CEUS was carried out using a multifrequency transducer (2-4 MHz) and a bolus injection of 2.4 mL SonoVue. The CEUS clips of the targeted lesion were recorded continuously for 6 minutes. By analyzing CEUS clips, parametric image could be obtained using the SonoLiver® software automatically. Quantitative parameters were compared between HCC and MLC groups. Receiver operating characteristic (ROC) curve analysis was further performed on parameters with significant difference between two groups.


RESULTS
On parametric imaging, the maximum intensity, rise time, time to peak, mean transit time and washout time for HCC and MLC were 185.6±148.0 vs. 95.2±58.6 (P = 0.003), 25.7±6.3 s vs. 23.8±8.8 s (P = 0.341), 30.7±7.9 s vs. 27.8±10.5 s (P = 0.246), 90.2±45.7 s vs. 89.3±40.3 s (P = 0.805), 63.4±29.5 s vs. 37.2±33.8 s (P = 0.005), respectively. ROC analysis was further performed for washout time and it showed a cut-off point of 43.765 s for the differentiation between HCC and MLC, with the AUC value of 0.780 (95% CI: 0.646-0.914). The corresponding diagnostic specificity, sensitivity and accuracy were 72.0%, 84.6% and 78.4% respectively.


CONCLUSIONS
Parametric imaging of CEUS can display perfusion effects of HCC and MLC objectively and visually and washout time may serve as a useful parameter on the differential diagnosis between HCC and MLC.
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Wen-Wen
WW
Yue
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.|Department of Ultrasound, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Shuo
S
Wang
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.|State Key Laboratory of High Performance Ceramic and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai, China.
Hui-Xiong
HX
Xu
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Li-Ping
LP
Sun
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Le-Hang
LH
Guo
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Xiao-Wan
XW
Bo
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Xiao-Long
XL
Li
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Chong-Ke
CK
Zhao
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Dan
D
Wang
Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Bo-Ji
BJ
Liu
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D014463:Ultrasonography / Q000379:methods*
D003287:Contrast Media
Contrast-enhanced ultrasound; hepatocellular carcinoma; metastatic liver cancer; parametric imaging; perfusion parameter