The Value Of Sonazoid Contrast-enhanced Ultrasound And Ultrasound Elastography In Diagnosis Of Focal Liver Lesions

Part I: Quantitative analysis and enhanced pattern of focal liver lesions in Sonazoid contrast-enhanced ultrasound Objectives:To compare the differences in Sonazoid contrast-enhanced ultrasound(SECEUS)enhancement patterns and quantitative characteristics between different kinds of focal liver lesions(FLLs).Methods:A SE-CEUS examination was performed on 71 patients who got treatment at our hospital between January 2022 and September 2022 and had focal liver lesions.73 lesions in all were gathered.Based on the results of the pathology or other enhanced imaging evaluation,they were divided into two groups: benign and malignant.(Surgical pathology or puncture pathology was used to confirm all malignant groups;certain benign groups were paired with enhanced MRI or enhanced CT).There were27 lesions in the benign group and 46 lesions in the malignant group.recorded the dynamic photos while observing the lesions’ enhancement process.recording and summarizing the vascular and Kupffer phase FLL enhancement pattern.The SECEUS time-intensity curve(TIC)was obtained with the aid of the quantitative contrast analysis software,and the arrival time(AT)and the time to peak(TTP)of the contrast agent intensity were obtained,the area under the curve(AUC)of the timeintensity curve of the contrast process was obtained from the time of arrival(AT),time to peak(TTP),rise time(RT),peak intensity(PI),and contrast intensity curve.Between the two groups of benign and malignant lesions,within the two groups of lesions,and in the peripheral liver parenchyma SE-CEUS,the differences in each contrast-enhanced ultrasonography feature and parameters were examined.Results:In the malignant group,32 lesions in the vascular phase showed quick enhancement in the early arterial phase,washout in the portal venous phase,8 lesions showed quick enhancement in the early arterial phase,simultaneous washout of portal phase with peripheral liver parenchyma,6 arterial phases did not show rapid enhancement and all malignant FLLs washout to different degrees in Kupffer phase.In the benign group,19 lesions showed concurrent enhancement with liver parenchyma and 8 lesions showed quick enhancement in the early arterial phase.All27 benign lesions showed simultaneous washout of the portal phase with peripheral liver parenchyma.25 benign lesions in the Kupffer phase were not a washout,and 2benign lesions were mildly washout.There was no statistically significant difference in AT,PI,or AUC between the two groups,however,TTP and RT were lower in the malignant group than in the benign group(P< 0.05),the malignant group had longer AT and TTP,bigger PI and AUC,and shorter AT and TTP when compared to peripheral parenchyma(P< 0.05).Conclusion:The appearance of SE-CEUS in the vascular phase of focal liver lesions is consistent with previous CEUS findings,and the distinctive Kupffer phase can aid in identification.For the lesions with atypical enhancement,the quantitative parameters of contrast-enhanced ultrasound can also be referred to a judge.PART II: Diagnostic value of shear wave elastography in focal liver lesionsObjectives:Researched the diagnostic value of SWE in identifying benign and malignant FLLs,and explored its optimal diagnostic value for identifying benign and malignant FLLs.Analyzed and compared the difference in shear wave elastography(SWE)hardness values of various types of FLLs.Methods:68 lesions(41 in the malignant group and 27 in the benign group)were eventually gathered that successfully passed the SWE test based on the first part of cases,after some lesions with lesion depth >80 mm and lesion placements close to the heart and big blood veins were excluded.The elastic stiffness values of the benign and malignant groups were compared.Moreover,the liver parenchyma surrounding the lesions’ Emean,Emax,and Emin values were determined.to identify the benignity and malignancy of FLLs,the Receiver Operating Characteristic Curve(ROC)was plotted to define the cut-off values of elastic stiffness values and to compare We evaluated the variations in elastic stiffness between the FLLs and the surrounding liver parenchyma.Results:The differences in Emean,Emax,and Emin between malignant and benign lesions were all statistically significant(all P<0.05).For Emean,Emax,and Emin,respectively,the area under the curve for predicting benign and malignant liver nodules was 0.860,0.781,and 0.654;the critical values were 11.42 k Pa,35.12 k Pa,and 6.29 k Pa,respectively.95.1% and 67.2%,80.5% and 74.1%,34.1% and 96.3%,respectively,were the sensitivity and specificity.Malignant lesions had higher Emean and Emax values than the normal liver parenchyma around them,while benign lesions had higher values than the normal liver parenchyma around them.These differences were statistically significant(all P< 0.05).Conclusion:Overall,the elastic hardness of malignant FLLs was higher than that of benign FLLs,but different types of benign and malignant FLLs had elastic hardness values that crossed,making it impossible to determine the nature of FLLs solely based on elastic hardness values and necessitating the addition of other ultrasound examinations.