Abstract:

Objective

To evaluate the value of contrast-enhanced ultrasound (CEUS)quantitative parameters in predicting microvascular invasion (MVI) and postoperative recurrence in hepatocellular carcinoma (HCC) patients, in order to provide a basis for clinical decision-making.

Methods

A total of 180 HCC patients admitted to Shanghai Eastern Hepatobiliary Surgery Hospital between August 2022 and August 2023 were included.Patient baseline characteristics and clinical data were collected.Based on postoperative pathology, the patients were divided into either an MVInegative group (M0) or an MVI-positive group (M1 and M2).The postoperative patients were followed until August 1, 2024, and recurrence was recorded.CEUS data including the washout ratio (WoR) of both the lesion and surrounding liver parenchyma were quantitatively analyzed.Logistic regression analysis was performed to identify independent predictors of MVI and 1-year postoperative recurrence.Receiver operating characteristic (ROC) curves were generated to evaluate predictive performance.

Results

Compared to the MVI-negative group (n=92), the MVI-positive group (n=88) exhibited significantly different tumor number (38.60% vs 20.70%; χ²=7.002, P=0.008), total bilirubin [(16.70±6.97) μmol/L vs (13.82±6.63)μmol/L; t=-2.842, P=0.008], prothrombin time [(12.45±1.24) s vs (11.76±1.32) s; t=-3.452, P=0.001],international normalized ratio [(1.04±0.11) vs (0.98±0.12); t=-3.354, P=0.002], lesion WoR [528.10(65.05, 591.82) a.u vs 996.09 (131.63, 1208.03) a.u; Z=-2.424, P=0.031], and liver parenchyma WoR[247.97 (64.5, 375.52) a.u vs 157.19 (26.55, 211.11) a.u; Z=-2.379, P=0.027].Multivariate logistic regression analysis identified tumor number (B=0.877, odds ratio (OR)=2.405, P=0.019), prothrombin time (B=0.362,OR=1.437, P=0.012), and lesion WoR (B=0.000, OR=1.000, P=0.022) as independent predictors of MVI,and their combination had an area under the ROC curve (AUC) of 0.754.Lesion WoR (B=0.000, OR=1.000,P=0.025) and liver parenchyma WoR (B=0.001, OR=1.001, P=0.042) were significantly associated with 1-year recurrence, yielding AUC values of 0.673 (95%CI: 0.568-0.778) and 0.625 (95%CI: 0.526-0.724),respectively.

Conclusion

CEUS quantitative parameters, particularly lesion WoR and liver parenchyma WoR, demonstrate significant clinical value in the preoperative prediction of MVI and postoperative recurrence in HCC patients.These findings provide critical insights for individualized surgical planning and prognostic assessment, highlighting their potential for broad clinical application.

Key words: Hepatocellular carcinoma, Contrast-enhanced ultrasound, Quantitative indices, Microvascular invasion