Clinical value of contrast-enhanced ultrasound in early diagnosis of small hepatocellular carcinoma (≤ 2 cm)

doi:10.12998/wjcc.v10.i24.8525

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World Journal of Clinical Cases

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Retrospective Study

World J Clin Cases. Aug 26, 2022; 10(24): 8525-8534
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8525

Clinical value of contrast-enhanced ultrasound in early diagnosis of small hepatocellular carcinoma (≤ 2 cm)

Qi Mei, Mei Yu, Qiong Chen

Qi Mei, Mei Yu, Department of Ultrasound, Shanghai Xuhui Dahua Hospital, Shanghai 200237, China

Qiong Chen, Department of Radiology, Shanghai Xuhui Dahua Hospital, Shanghai 200237, China

Author contributions: Mei Q and Yu M contributed equally to this study; Chen Q designed the research study; Yu M performed the research; Yu M contributed new reagents and analytic tools; Mei Q analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.

Supported by National Natural Science Foundation of China, No. 81571675; Academic Experience and Research Workshop Construction Project of Shanghai Famous TCM Doctors, No. JCZYGZS-008; and Clinical Study on Control and Clearance of Hepatitis B Surface Antigen by Traditional Chinese Medicine, No. 1340190290A.

Institutional review board statement: The study was reviewed and approved by the Dahua Hospital of Xuhui District Institutional Review Board (No. 201607).

Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.

Conflict-of-interest statement: Dr. Chen reports non-financial support from National Natural Science Foundation of China, personal fees from the Academic Experience and Research Workshop Construction Project of Shanghai Famous TCM Doctors, personal fees from the Clinical Study on Control and Clearance of Hepatitis B Surface Antigen by Traditional Chinese Medicine, during the conduct of the study.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at cq1444@sina.com.

Corresponding author: Qiong Chen, MSc, Chief Doctor, Department of Radiology, Shanghai Xuhui Dahua Hospital, No. 901 Old Humin Road, Xuhui District, Shanghai 200237, China. cq1444@sina.com

Received: February 19, 2022
Peer-review started: February 19, 2022
First decision: April 19, 2022
Revised: May 10, 2022
Accepted: July 16, 2022
Article in press: July 16, 2022
Published online: August 26, 2022
Processing time: 177 Days and 20.7 Hours

ARTICLE HIGHLIGHTS

Research background

Contrast-enhanced ultrasound (CEUS) is challenging in the diagnosis of small hepatocellular carcinoma (HCC) with a diameter of less than 2 cm.

Research motivation

Many studies have explored the CEUS images of HCC larger than 20 mm, but comparative studies between HCC nodules ≤ 1 cm and those 1–2 cm are rare. However, this study compared the enhancement mode of CEUS for small HCC nodules ≤ 2 cm of different sizes.

Research objectives

To investigate the clinical value of CEUS in the early detection of small HCC with high risk factors, especially to compare the enhancement mode of CEUS for small HCC nodules ≤ 2 cm of different sizes.

Research methods

Conventional ultrasonography combined with CEUS was adopted to analyze the echo, size, location, and enhancement characteristics of benign and malignant nodules, as well as the enhancement methods for HCC with different diameters.

Research results

Conventional ultrasonography combined with CEUS revealed 65 (11.80%) nodules with a follow-up diagnosis of HCC, 19 (3.45%) dysplastic nodules, and 467 (84.75%) benign cirrhotic hyperplastic nodules. There were 40 cases (61.54%) of HCC transformed from hypoechoic nodules, 9 (13.85%) from hyperechoic nodules, and the remaining 16 (24.62%) from isoechoic nodules. Significant differences in CEUS characteristics were found among cirrhotic nodules, dysplastic nodules, and HCC nodules in each phase. Significant differences in the enhancement mode were observed between nodules ≤ 1 cm and those 1–2 cm.

Research conclusions

Conventional ultrasonography combined with CEUS could identify small HCCs and help monitor patients with an early diagnosis of HCC. Significant differences in the enhancement mode were noted between nodules ≤ 1 cm and those between 1–2 cm. The smaller the HCC nodule, the later the contrast agent began to flush and the longer the duration of contrast enhancement.

Research perspectives

Small HCC ultrasound imaging enhancement pattern compared with other medical imaging enhancement pattern is the research direction in the future.