| Objective:To investigate the diagnostic ability of Contrast-enhanced Ultrasonography(CEUS),Contrast-enhanced CT(CECT),and Gadolinium ethoxybenzyl diethylenetriaminepent aacetic acid(Gd-EOB-DTPA)MRI in HBV-related hepatocellular carcinoma(HCC)(≤3cm),and to evaluate the diagnostic value of CEUS combined with CECT or CEUS combined with Gd-EOB-DTPA MRI in HBV-related HCC(≤2cm).The optimal diagnosis method was selected for HBV-related HCC with the lesion less than 3cm,to improve the diagnosis rate of HBV-related HCC,in order to achieve early diagnosis and early treatment,to improve the prognosis of HCC with Hepatitis B virus.Methods:From June 2010 to June 2016,patients with chronic viral hepatitis B virus or hepatitis B cirrhosis who were admitted to the third central hospital of Tianjin were selected for screening to identify focal liver lesions.A total of 269 cases were diagnosed pathologically and completed at least two imaging examinations(CEUS,CECT,and Gd-EOB-DTPA MRI)within four weeks of finding lesions.The pathological diagnosis was confirmed as HCC with CEUS indicated that the lesion diameter during 3cm or as high-grade dysplasia nodule(HGDN)or Cirrhotic regenerative nodule(CRN).According to pathological diagnosis,the patients were divided into CRN group(53 cases),HGDN group(62 cases),and HCC group(154 cases).The HCC group was divided into twogroups according to lesion size: HCC(≤2cm)group(75 cases)and HCC(2-3c m)group(79 cases).Statistical software SPSS 23.0 was used for MCRNemanrt est to evaluate the diagnostic ability of HBV-related HCC with CEUS,CECT,and Gd-EOB-DTPA MRI in the lesions less than 3cm.In addition,ROC curve was used to evaluate the diagnostic value of combined diagnosis for HBV-related HCC(≤2cm).Result:1.The difference of age between the CRN group and the HCC group、the HGDN group was statistically significant(P=0.000,P=0.000),the average age level of the CRN group was significantly lower than that of the other two groups.In terms of gender,the difference between the CRN group and the HCC group、the HGDN group was statistically significant(P=0.000,P=0.017).The proportion of female patients in the CRN group was larger than that in the other two groups.In terms of gender composition,the proportion of male patients was larger than that of female patients.Serum AFP levels in the HCC group were significantly different from those in the HGDN group and the CRN group(P=0.000,P=0.000),and the average serum AFP levels in the HCC group were significantly higher than those in the HGDN group and the CRN group.2.Among the 62 patients with HGDN,45(39.1%)showed typical enhancement mode in CEUS,32(29.1%)in CECT,and 7(24.1%)in Gd-EOB-DTPA MRI.When diagnosing HGDN and CRN,the diagnostic ability of CEUS,CECT and Gd-EOB-DTPA MRI is equivalent.The three diagnostic methods have low specificity in distinguishing HCC from HGDN.3.In the evaluation of diagnostic ability,CEUS was superior to CECT and Gd-EOB-DTPA MRI in the diagnosis of HCC(≤3cm),while Gd-EOB-DTPA MRI was superior to CECT.When the lesion was 2cm,the diagnostic capacity of Gd-EOB-DTPA MRI was better than CECT,while when the lesion was 2-3cm,the diagnostic capacity of Gd-EOB-DTPA MRI was equivalent to of CECT.4.It’s used to diagnosis HCC(≤2cm)and non cancer nodules that CEUS combined CECT,the AUC value(0.806)of combined diagnosis was higher than that of CEUS and CECT(0.768,0.656).The AUC value(0.768)of CEUS combined with Gd-EOB-DTPA MRI was greater than that of CEUS and Gd-EOB-DTPA MRI(0.757,0.648).The diagnostic value of combined diagnosis was higher than that of CEUS alone,CECT alone and Gd-EOB-DTPA MRI alone.The AUC value(0.800)of combined CECT with CEUS for HCC(≤2 cm)and CRN diagnosis was lower than that of CEUS(0.945).The AUC value(0.768)of CEUS combined with Gd-EOB-DTPA MRI was lower than that of CEUS(0.853).The diagnostic value of combined diagnos-is was lower than th-at of CEUS alone.Conclusion:1.In the diagnosis of HCC(≤3cm),CEUS has the highest diagnostic abi-l ity,followed by Gd-EOB-DTPA MRI and CECT.In terms of sensitivity,accurac y,positive predictive value and negative predictive value,CEUS was signific-a ntly higher than CECT and Gd-EOB-DTPA MRI.In the diagnosis of HCC,HGDN,the specificity of the three diagnostic meth-ods were all low.2.When the lesion was 2cm,the diagnostic capacityof Gd-EOB-DTPA MRI was better than CECT,while when the lesion was 2-3cm,the diagnostic capacity of Gd-EOB-DTPA MRI was equivalent to of CECT.3.In the differentiation between HGDN and CRN,the diagnostic ability of three imaging methods including CEUS,CECT and Gd-EOB-DTPA MRI was similar.4.In the diagnosis of HCC(≤2cm)and non-malignant nodules,the diagnos ticvalue of the two diagnostic strategies of CEUS combined with CECT and CEUS combined with Gd-EOB-DTPA MRI was lower than Single imaging method.The diagnostic value of combined diagnosis in HCC(≤2cm)and CRN were higher than single CEUS. |
