Comparison of contrast-enhanced ultrasound features between hepatocellular adenoma and hepatocellular carcinoma

doi:10.3877/cma.j.issn.1672-6448.2022.11.011

Abstract

Abstract:

Objective

To compare the contrast-enhanced ultrasound (CEUS) features between hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC).

Methods

From March 2014 to May 2019, 30 HCA patients with 30 lesions and 56 HCC patients with 56 lesions that were detected by CEUS examination and then confirmed pathologically at the Department of Ultrasound of Zhongshan Hospital, Fudan University were retrospectively analyzed. The differences in enhancement pattern in the arterial phase, subcapsular vessel hyperenhancement, and washout in the portal venous and delayed phases were compared by the Chi-square test or Fisher exact test. The efficacy of CEUS features in the diagnosis of HCA and HCC was evaluated by the four-grid diagnostic table method.

Results

All HCA and HCC lesions showed hyperenhancement in the arterial phase, and both types of lesions mainly manifested as diffuse filling pattern (86.7% vs 94.6%), with no statistically significant difference in enhancement pattern (P=0.417) or homogeneity at the peak time (P=0.483). Subcapsular vessel hyperenhancement was observed in 43.3% (13/30) of HCA and 8.9% (5/56) of HCC lesions (χ²=11.971, P=0.001). In the portal venous phase, HCA more often showed hyper-or iso-enhancement than HCC (13.4%/0 vs 43.3%/17.9%), and the difference was statistically significant (χ²=15.605, P<0.001). In the delayed phase, HCC more frequently exhibited hypo-enhancement than HCA (92.9% vs 56.7%, χ²=16.184, P<0.001). Based on "arterial hyper-enhancement and portal or delayed washout" on CEUS, the sensitivity, specificity, and accuracy for diagnosis of HCC were 92.9%, 80.0%, and 88.4%, respectively. Based on either "arterial hyper-enhancement and sustained portal or delayed hyper- or iso-enhancement" or "subcapsular vessel hyperenhancement", the sensitivity, specificity, and accuracy for diagnosis of HCA were 77.4%, 89.1%, and 84.9%, respectively.

Conclusion

CEUS features of subcapsular vessel hyperenhancement in the arterial phase and enhancement pattern in the portal venous and delayed phases are different between HCA and HCC, which are helpful to distinguish HCA from HCC.

Key words: Hepatocellular adenoma, Hepatocellular carcinoma, Contrast-enhanced ultrasound, Subcapsular vessel hyperenhancement

Kailing Chen, Weibin Zhang, Feng Mao, Hong Han, Chaolun Li, Yi Dong, Wenping Wang. Comparison of contrast-enhanced ultrasound features between hepatocellular adenoma and hepatocellular carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(11): 1218-1224.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2022.11.011

https://chaosheng.cma-cmc.com.cn/EN/Y2022/V19/I11/1218

Figures/Tables 7

组别	例数	性别		体质量指数［kg/m²，M（Q_R）］	激素类药物服用史（例）		甲胎蛋白（ng/ml，例）		乙肝表面抗原（例）		肝细胞脂肪变性（例）		肝纤维化分级（例）
组别	例数	男	女	体质量指数［kg/m²，M（Q_R）］	有	无	≥20	＜20	阳性	阴性	有	无	S_0-2	S_3-4
HCA	30	20	10	22.7（21.3~26.9）	3	27	0	30	4	26	8	22	27	3
HCC	56	45	11	22.4（21.1~27.3）	4	52	41	15	47	9	17	39	18	38
统计值		χ²=1.984		U=1.337	χ²=0.213		χ²=41.976		χ²=37.467		χ²=0.129		χ²=26.214
P值		0.159		0.079	0.644		＜0.001		＜0.001		0.719		＜0.001

特征	HCA（n=30）	HCC（n=56）	统计值	P值
病灶最大径（mm， $x ¯$ ±s）	34.90±12.06	31.82±24.79	t=1.377	0.309
病灶位置［个（%）］			χ²=0.672	0.715
右叶	23（76.7）	44（78.6）
左叶	7（23.3）	11（19.6）
尾状叶	0	1（1.8）
内部回声［个（%）］			χ²=1.991	0.618
高回声	3（10.0）	9（16.1）
等等回声	2（6.7）	1（1.8）
低回声	23（76.6）	41（73.2）
混合回声	2（6.7）	5（8.9）
均匀性［个（%）］			χ²=0.133	0.716
均匀	13（43.3）	22（39.3）
不均匀	17（56.7）	34（60.7）
内部无回声区［个（%）］			—	0.332
有	1（3.3）	5（8.9）
无	29（96.7）	51（91.1）
形态［个（%）］			χ²=1.366	0.243
规则	21（70.0）	32（57.1）
不规则	9（30.0）	24（42.9）
边界［个（%）］			χ²=1.838	0.175
清晰	24（80.0）	37（66.1）
不清晰	6（20.0）	19（33.9）
钙化［个（%）］			—	0.472
有	1（3.3）	4（7.1）
无	29（96.7）	52（92.9）
周边暗环［个（%）］			—	0.023
有	3（10.0）	18（32.1）
无	27（90.0）	38（67.9）
阻力指数［M（Q_R）］	0.54（0.47，0.66）	0.67（0.54，1.00）	Z=4.327	0.041

特征	HCA（n=30）	HCC（n=56）	统计值	P值
病灶最大径（mm， $x ¯$ ±s）	34.90±12.06	31.82±24.79	t=1.377	0.309
病灶位置［个（%）］			χ²=0.672	0.715
右叶	23（76.7）	44（78.6）
左叶	7（23.3）	11（19.6）
尾状叶	0	1（1.8）
内部回声［个（%）］			χ²=1.991	0.618
高回声	3（10.0）	9（16.1）
等等回声	2（6.7）	1（1.8）
低回声	23（76.6）	41（73.2）
混合回声	2（6.7）	5（8.9）
均匀性［个（%）］			χ²=0.133	0.716
均匀	13（43.3）	22（39.3）
不均匀	17（56.7）	34（60.7）
内部无回声区［个（%）］			—	0.332
有	1（3.3）	5（8.9）
无	29（96.7）	51（91.1）
形态［个（%）］			χ²=1.366	0.243
规则	21（70.0）	32（57.1）
不规则	9（30.0）	24（42.9）
边界［个（%）］			χ²=1.838	0.175
清晰	24（80.0）	37（66.1）
不清晰	6（20.0）	19（33.9）
钙化［个（%）］			—	0.472
有	1（3.3）	4（7.1）
无	29（96.7）	52（92.9）
周边暗环［个（%）］			—	0.023
有	3（10.0）	18（32.1）
无	27（90.0）	38（67.9）
阻力指数［M（Q_R）］	0.54（0.47，0.66）	0.67（0.54，1.00）	Z=4.327	0.041

特征	HCA（n=30）	HCC（n=56）	χ²值	P值
动脉期增强程度
高增强	30（100）	56（100）	—	—
动脉期增强方式			2.103	0.417
向心性增强	3（10.0）	2（3.6）
离心性增强	1（3.3）	1（1.8）
整体增强	26（86.7）	53（94.6）
动脉期达峰时均匀性				0.483
均匀	28（93.3）	48（85.7）
不均匀	2（6.7）	8（14.3）
门脉期增强程度			15.605	＜0.001
高增强	4（13.4）	0（0）
等增强	13（43.3）	10（17.9）
低增强	13（43.3）	46（82.1）
延迟期增强程度			16.184	＜0.001
高增强	4（13.3）	0
等增强	9（30.0）	4（7.1）
低增强	17（56.7）	52（92.9）
包膜下增强血管影	13（43.3）	5（8.9）	11.971	0.001
始终不增强区	2（6.7）	7（12.5）		0.400

超声造影	病理		合计
超声造影	HCC	HCA	合计
HCC	52	6	58
HCA	4	24	28
合计	56	30	86

超声造影	病理		合计
超声造影	HCA	HCC	合计
HCA	23	6	29
HCC	7	50	57
合计	30	56	86

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