| ObjectiveTo observe the manifestation of focal nodular hyperplasia(FNH)and hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound(CEUS); to evaluate the value of the model and quantitative parameters of contrast-enhanced ultrasound in the differential diagnosis of FNH and HCC.Methods17 patients with diagnosed FNH (FNH group) and 57 patients with diagnosed HCC (HCC group) underwent examination of CEUS before the surgical operation or transcutaneous biopsy guided by ultrasound in 15 days. CEUS was performed with SonoVue and pulse-inversion harmonic imaging (PIHI). Each subject was administrated with a bolus injection of the ultrasound microbubble agent SonoVue (2.4ml) into an arm vein. The blood perfusion characteristics of tumors were observed after the injection of contrast ultrasound agent (SonoVue). The process of CEUS is divided into three phase:arterial phase(from 8s to 30s); portal venous phase (from 31s to 120s); late phase (after 120S). The two groups were analyzed with their enhancing model in every vascular phase of CEUS. The time-intensity curves of the lesions in FNH and HCC which were equal or high enhanced in portal venous phase were drawn by QLab software. The arrival time (AT), time to peak (TTP) and peak intensity(PI) of the liver lesions were measured by time-intensity curve software. The enhancement time (ET) and ascending slope (AS) were calculated with these parameters. The parameters in FNH group were compared with that in HCC group which were equal or high enhanced in portal venous phase by statistical method.Results16 of 17 (94.12%) FNH were high enhanced in arterial phase, and one of them was equal enhanced in arterial phase; 9 of 17 (52.94%) FNH were high enhanced both in portal venous phase and late phase, and 8 of 17 (47.06%)FNH were equal enhanced both in portal venous phase and late phase. In HCC group, there were 55 of 57 (96.49%) HCC high enhanced in arterial phase, and 2 of 57 (0.04%) HCC were equal enhanced in arterial phase; in portal venous phase,36 of 57 (63.16%) HCC were low enhanced,20 of them (35.09%) were equal enhanced, and one of HCC was high enhanced; 50 of 57 (87.72%) HCC were low enhanced in late phase,6 of 57 (10.53%) HCC were equal enhanced and one of them was high enhanced in late phase.The enhancing model of FNH group and HCC group showed statistical significance in portal venous phase and late phase(p=0.000), but showed no difference in arterial phase. In other words, FNH group and HCC gtoup were both high enhanced in arterial phase, but the expurgation of contrast agent is earlier in HCC group than that in FNH group. Quantitative parameters of FNH and HCC which were equal or high enhanced in portal venous phase:(1) AT:FNH group:(10.53±3.44)s, HCC group:(13.11±3.96)s; (2) TTP: FNH group:(17.59±6.37)s, HCC group:(24.54±9.18)s; (3) ET:FNH group:(7.06±3.30)s, HCC group:(11.32±7.03)s. All of the above parameters showed statistical significance between FNH group and HCC groups (P＜0.05). (4)PI:FNH group:(56.97±40.60)dB, HCC group: (68.80±38.32)dB; (5) AS:FNH group:(9.08±5.35)dB/s, HCCgroup: (7.11±4.12)dB/s. No difference was observed between two groups in these two parameters (P>0.05).ConclusionsThe enhancing model of FNH was "fast-in and slow-out" in CEUS, while the most of HCC in CEUS was "fast-in and fast-out". The expurgation of contrast agent is earlier in HCC group than that in FNH group. The enhancing model of FNH group and HCC group showed statistical significance both in portal venous phase and late phase. Compared with HCC which were equal or high enhanced in portal venous phase by quantitative parameters of the time-intensity curves, AT and TTP are earlier in FNH group than in HCC group, and ET is shorter in FNH group than in HCC group. The quantitative analysis of contrast-enhanced ultrasound can be benefit for the differential diagnosis of FNH and HCC. |
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