Diagnosis efficacy of CEUS for hepatic inflammatory lesions

Abstract

Purpose: In this study, the efficacy of US/CEUS and clinicopathologic parameters in differential diagnosis of hepatic inflammatory lesions were evaluated.

Methods: This was a retrospective study in which CEUS imaging was performed on 182 patients. Among these patients, 44 patients had hepatic inflammatory lesions and 138 patients had malignant lesions. The ultrasound (US), CEUS, and clinicopathologic parameters with respect to differential diagnosis of hepatic inflammatory lesions were analyzed.

Results: Irregular lesion shape and unclear margin were commonly seen in hepatic inflammatory lesions by US/CEUS examination. Hypoenhancement in arterial phase (AP) and portal venous phase (PVP), and isoenhancement in delayed phase (DP) were more commonly found in inflammatory lesions rather than malignant lesions [9% (4/44), 68% (30/44), and 16% (7/44) vs 2% (3/138), 11% (15/138), 1% (1/138), respectively; P < .05]. The enhancement coverage was also a significant indicator for the differentiation of inflammatory lesions and malignant lesions (P < .05). History of hepatitis or cirrhosis, and higher serum alpha-fetoprotein (AFP) level were indicators for malignant lesions, while liver parasites and higher body temperature were indicators for inflammatory lesions. When the US/CEUS findings were combined with clinicopathologic parameters, the diagnostic accuracy of inflammatory lesions could reach 93.3%, with sensitivity, specificity, positive predictive value, and negative predictive value of 63.64%, 96.03%, 84.85%, and 88.32%, respectively.

Conclusion: The US/CEUS findings combined with clinical characteristics can accurately differentiate hepatic inflammatory lesions and malignant lesions. The results of study will improve the diagnostic confidence for hepatic inflammatory lesions.

Keywords: contrast-enhanced ultrasound imaging; differential diagnosis; hepatic inflammatory lesion.

Figure 1

US/CEUS examination. A, Hypoechoic mass of right lobe of liver; B, the arterial phase showed rapid and high enhancement; C, the portal phase began to clear

Figure 2

Enhancement in DP was significantly associated with malignant lesions or inflammatory lesions (P < .05), and 16% (7/44) of patients with isoenhancement in the DP had evidence of IL, compared to 1% (1/138) of patients with malignant lesions

Figure 3

The enhancement coverage with isoenhancement or hyperenhancement during the arterial phase. The enhancement coverage has significant association with malignant lesions or inflammatory lesions (P < .05)

Figure 4

The efficiency of CEUS for IL or malignant lesions. ROC curve for the correctly diagnosed rate of CEUS. The area under the ROC curve = 0.74

Figure 5

The efficiency of the five independent factors. ROC curve for the correctly diagnosed rate of the five independent factors. The area under the ROC curve = 0.93