Published online Oct 15, 2025. doi: 10.4251/wjgo.v17.i10.109506
Revised: July 10, 2025
Accepted: August 21, 2025
Published online: October 15, 2025
Processing time: 125 Days and 23.7 Hours
Contrast-enhanced ultrasound (CEUS) offers valuable reference data for the early diagnosis of hepatocellular carcinoma (HCC) through dynamic enhancement patterns and quantitative analysis.
To evaluate the clinical value, diagnostic accuracy, and imaging characteristics of CEUS in the early diagnosis of HCC and its correlation with HCC pathological findings.
This single-center retrospective study included 125 patients suspected of having primary liver cancer who underwent CEUS at the Department of Hepatobiliary Surgery and Imaging of our hospital from January 2022 to March 2024. All patients were diagnosed with HCC via postoperative pathology or puncture histology. All patients underwent conventional ultrasound examination and CEUS, while some underwent computed tomography or magnetic resonance imaging examination. Clinical data, liver function, serological indicators, and imaging results were collected. Key CEUS indicators, including arterial phase enhancement time (APT) and peak enhancement intensity (PEI), were analyzed.
Of the 125 patients, 66.40% were male, with a mean age of 56.74 ± 11.25 years. Conventional type HCC accounted for 71.20%, with histological grades I (14.40%), II (51.20%), and III-IV (34.40%). CEUS enhancement patterns included “fast-in and fast-out” (36%), “fast-in and slow-out” (40%), and “continuous enhancement” (24%). APT < 15 seconds was observed in 40% of patients, and PEI ≥ 1.5 in 56%. Correlation analysis revealed significant negative correlations between tumor differentiation grade and APT, washout completion time, and longest diameter (P < 0.01). Logistic regression identified PEI [odds ratio (OR) = 3.374], WIT (OR = 0.541), lesion boundary characteristics, and APT (OR = 0.471) as significant predictors. Receiver operating characteristic analysis demonstrated high diagnostic performance: PEI (area under the curve = 0.893), WIT (0.851), lesion boundary characteristics (0.876), and APT (0.864), all with Youden’s index > 0.4. Subgroup analysis showed comparable overall diagnostic performance between CEUS and computed tomography/magnetic resonance imaging, but computed tomography/magnetic resonance imaging had higher sensitivity and specificity for Liver Imaging Reporting and Data System 5 lesions (P = 0.032).
CEUS holds significant clinical value in the early diagnosis of HCC, as it effectively identifies the typical imaging characteristics of early-stage HCC through dynamic contrast enhancement and quantitative analysis, particularly during the arterial and portal phases. As a non-invasive, cost-effective, and efficient imaging modality, CEUS has a broad clinical application potential.
Core Tip: Contrast-enhanced ultrasound (CEUS) plays an important role in the early diagnosis of hepatocellular carcinoma. By observing characteristic enhancement patterns - such as arterial phase hyperenhancement and portal/delayed phase washout - CEUS provides critical insights into tumor vascularity and behavior. Quantitative indicators such as arterial phase time and peak enhancement intensity further improve diagnostic accuracy. Compared with computed tomography or magnetic resonance imaging, CEUS offers advantages including real-time imaging, lower cost, no ionizing radiation, and better sensitivity for small or early-stage lesions. These strengths support its use in early detection, pathological correlation, and timely clinical intervention for hepatocellular carcinoma.