Comparative Study On Diagnostic Value Of Em-cfDNA And Contrast Enhanced Ultrasound In Hepatic Alveolar Echinococcosis

Objective:Objective to compare and analyze the diagnostic value of two different methods for hepatic alveolar echinococcosis by detecting circulating free DNA of Echinococcus multilocularis(Em-cfDNA)and contrast-enhanced ultrasound.Methods:45 patients with hepatic alveolar echinococcosis admitted to the Department of hepatobiliary and pancreatic surgery,Affiliated Hospital of Qinghai University from June 2019 to December 2020 were selected as the research objects.The postoperative patnology was used as the gold standard.Use next-generation sequencing(NGS)to analyze Em-cfDNA in plasma samples of all patients,and after determining the corresponding sequence number,evaluate the value of using Em-cfDNA in the diagnosis of HAE.At the same time,the characteristics of contrast-enhanced ultrasound in patients with hepatic alveolar echinococcosis were analyzed to further compare the diagnostic efficacy of Em-cfDNA and contrast-enhanced ultrasound in hepatic alveolar echinococcosis.Results:1.A total of 64 lesions were detected in 40 patients,and 40 lesions with acceptable image quality were selected.The longest diameter and area of lesions measured in contrast-enhanced ultrasound(CEUS)mode were significantly larger than those measured in conventional ultrasound(US)mode(P=0.001,P=0.002).US examination of 40 lesions showed that all lesions had irregular edges,fuzzy boundaries,unclear boundaries with surrounding tissues,uneven internal echo of lesions,and no blood flow signal was detected in the boundary and internal of lesions by color Doppler flow imaging(CDFI).The accuracy rate of US diagnosis of HAE was 70%(28/12).CEUS showed that 37 cases of lesions in arterial phase had rim ring enhancement with uneven enhancement,3 cases had no rim enhancement,34 cases had no enhancement in three phases of lesions,6 cases had patch enhancement in three phases of lesions;the results showed that the accuracy rate of CEUS in the diagnosis of HAE was 90%(36/40)higher than that of US,and the difference between the two groups was statistically significant(P=0.025).2.Among 41 patients with HAE,39 cases were detected for Em-cfDNA,and the positive rate was 95%.The levels of Em-cfDNA in lesions≥5cm in diameter was higher than that in lesions<5cm in diameter,and the level of Em-cfDNA could reflect the size of lesions.The difference between the two groups was statistically significant(z=-2.502,P<0.05),There was no significant relationship between the number and stage of lesions and the level of Em-cfDNA(z=-0.406,P=0.688;H=1.797,P=0.407).3.40 cases of HAE patients,preoperative CEUS and Em-cfDNA examination,CEUS diagnostic results compared with Em-cfDNA test results,CEUS diagnostic accuracy was 90%,Em-cfDNA was 95%;there was no significant difference between the two groups(x~2=0.180,P=0.671).Conclusion:1.Compared with US,CEUS can provide HAE with three-phase"negative imaging"characteristic imaging performance,which is a more accurate technique for diagnosing and differential diagnosis of HAE.2.Em-cfDNA is a new and effective diagnostic marker for HAE,which provides reliable diagnostic methods before surgery.3.Em-cfDNA is superior to CEUS in diagnosing HAE.However,the cost of testing is expensive,and it is more suitable for the diagnosis and differential diagnosis of atypical cases.