Parametric imaging with contrast-enhanced ultrasound for differentiating hepatocellular carcinoma from metastatic liver cancer

Article type: Research Article

Authors: Yue, Wen-Wen^{a; 1} | Wang, Shuo^{a; b; 1} | Xu, Hui-Xiong^{a; c; *} | Sun, Li-Ping^a | Guo, Le-Hang^a | Bo, Xiao-Wan^a | Li, Xiao-Long^a | Zhao, Chong-Ke^a | Wang, Dan^a | Liu, Bo-Ji^a

Affiliations: [a] Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China | [b] Department of Ultrasound, Tongji Hospital, Tongji University School of Medicine, Shanghai, China | [c] State Key Laboratory of High Performance Ceramic and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai, China

Correspondence: [*] Corresponding author: Hui-Xiong Xu, MD, PhD, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, No. 301, Yanchangzhong Road, Shanghai 200072, China. Tel.: +86 18917683519; Fax: +86 021 66307539; E-mail: xuhuixiong@126.com.

Note: [1] Wen-Wen Yue and Shuo Wang contributed equally to this work.

Abstract: AIM: To evaluate the diagnostic performance of parametric imaging with contrast-enhanced ultrasound(CEUS) for differentiating hepatocellular carcinoma(HCC) from metastatic liver cancer(MLC). METHODS: 30 HCCs (mean diameter, 3.6±1.3 cm; range, 2.1–5.0 cm) and 30 MLCs (mean diameter, 2.8±1.5 cm; range, 1.2–5.0 cm) pathologically diagnosed or confirmed by clinical criteria that underwent CEUS were randomly included. CEUS was carried out using a multifrequency transducer (2–4 MHz) and a bolus injection of 2.4 mL SonoVue. The CEUS clips of the targeted lesion were recorded continuously for 6 minutes. By analyzing CEUS clips, parametric image could be obtained using the SonoLiver® software automatically. Quantitative parameters were compared between HCC and MLC groups. Receiver operating characteristic (ROC) curve analysis was further performed on parameters with significant difference between two groups. RESULTS: On parametric imaging, the maximum intensity, rise time, time to peak, mean transit time and washout time for HCC and MLC were 185.6±148.0 vs. 95.2±58.6 (P = 0.003), 25.7±6.3 s vs. 23.8±8.8 s (P = 0.341), 30.7±7.9 s vs. 27.8±10.5 s (P = 0.246), 90.2±45.7 s vs. 89.3±40.3 s (P = 0.805), 63.4±29.5 s vs. 37.2±33.8 s (P = 0.005), respectively. ROC analysis was further performed for washout time and it showed a cut-off point of 43.765 s for the differentiation between HCC and MLC, with the AUC value of 0.780 (95% CI: 0.646–0.914). The corresponding diagnostic specificity, sensitivity and accuracy were 72.0%, 84.6% and 78.4% respectively. CONCLUSIONS: Parametric imaging of CEUS can display perfusion effects of HCC and MLC objectively and visually and washout time may serve as a useful parameter on the differential diagnosis between HCC and MLC.

Keywords: Contrast-enhanced ultrasound, hepatocellular carcinoma, metastatic liver cancer, parametric imaging, perfusion parameter

DOI: 10.3233/CH-162060

Journal: Clinical Hemorheology and Microcirculation, vol. 64, no. 2, pp. 177-188, 2016