A Nomogram Based on Contrast-Enhanced Ultrasound to Predict the Microvascular Invasion in Hepatocellular Carcinoma.

OBJECTIVE: The aim of this study was to establish and validate a contrast-enhanced ultrasound (CEUS) nomogram for pre-operative microvascular invasion (MVI) prediction in hepatocellular carcinoma (HCC), and compare it with the nomogram based on gadopentetate dimeglumine-enhanced magnetic resonance imaging (Gd-MRI). METHODS: A total of 251 patients with a single HCC were enrolled in this prospective study, including 176 patients in the training cohort and 75 patients in the validation cohort. Contrast-enhanced ultrasound (CEUS) with Sonazoid and Gd-MRI was performed pre-operatively. Post-operative histopathology was the gold standard for MVI. Univariate and multivariate logistic regression was performed to determine independent risk factors for MVI. Nomograms based on CEUS and Gd-MRI were established, and their discrimination, calibration and decision curve analysis were evaluated and compared. RESULTS: Multivariate logistic regression revealed that arterial circular enhancement, non-enhancing area and thick ring-like enhancement in the post-vascular phase were independent risk factors for MVI. The areas under the receiver operating characteristic curve of the nomogram were 0.841 (0.779-0.892) and 0.914 (0.827-0.966) in the training and validation cohorts, with no significant difference compared with the Gd-MRI nomogram (p = 0.294, 0.321). The C-indexes were 0.821 and 0.870 in the training and validation cohorts. Decision curve analysis revealed that the CEUS nomogram had better clinical applicability than the Gd-MRI nomogram when the threshold probability was between 0.35 and 0.95. CONCLUSION: The CEUS-based nomogram was available for predicting MVI in HCC, and its predictive performance was not inferior to that of Gd-MRI.

Ring-like enhancement on Contrast-Enhanced ultrasound may correlate well with histopathological capsule of Hepatocellular Carcinoma: Comparison with the enhancing capsule on Gadopentetate-enhanced MRI.

PURPOSE: To evaluate the correlation of ring-like enhancement (RE) on contrast-enhanced ultrasound with Sonazoid (S-CEUS) with the fibrous capsule of HCC, and compared it with the enhancing capsule on Gadopentetate-enhanced MRI (Gd-MRI). METHOD: Consecutive patients with pathologically-proven resected HCCs from January 2021 to December 2021 were reviewed in this retrospective study. Preoperatively, the RE on the S-CEUS and the enhancing capsule on Gd-MRI were evaluated for each lesion. We analyzed the correlation of the presence, integrity, and thickness of imaging features with the histopathological fibrous capsule. The diagnostic performance to recognize the capsule between two modalities was compared by the McNemar test. RESULTS: Ninety-one patients (mean age, 58.30 ± 11.13 years; 82 men) with ninety-seven HCCs (mean size, 4.67 ± 2.70 cm) were reviewed. The RE on S-CEUS correlated with the presence of the fibrous capsule (P = 0.006). The sensitivity, specificity, and accuracy were 92.05 %, 44.44 %, and 82.47 %, respectively, which was not different from Gd-MRI (P = 0.388). The integrity of RE in the post-vascular phase correlated with the integrity of the fibrous capsule (P = 0.018), whose diagnostic performance was not statistically different from Gd-MRI (P > 0.999). The thickness shown both on S-CEUS and Gd-MRI was thicker than that in histopathology (P < 0.001), and the thickness on Gd-MRI was not statistically different from that in the vascular phase of S-CEUS (P = 0.563), but thinner than that in the post-vascular phase (P = 0.001). CONCLUSIONS: Compared with the Gd-MRI, RE on S-CEUS had a similarly well correlation with the presence and integrity of fibrous capsule of HCC.

Discrepancy of contrast-enhanced ultrasonographic pattern with two contrast agents in steatohepatitic subtype hepatocellular carcinoma: A case report.

Contrast-enhanced ultrasound (CEUS) is one of the important imaging modalities for diagnosis of hepatocellular carcinoma (HCC). Sonovue and Sonazoid are the third-generation of ultrasound contrast agents that have been commercialized and widely used in clinical applications. This study introduces the imaging differences between these two agents in vascular phases for the first time. A 54-year-old man clinical suspected liver cancer. He had chronic hepatitis B for more than 20 years. The result of alpha-fetoprotein was 36.45µg/L (normal< 20µg/L). The imaging pattern of CEUS with Sonovue was "fast-in and fast-out" performance, while the pattern of "fast-out" was absent after portal phase with Sonazoid, even in Kupffer phase. The lesion was diagnosed as lipid-rich HCC by contrast-enhanced MRI. After liver resection, pathology revealed that it was hepatocellular carcinoma contained poor-differentiated steatohepatitis subtype and moderate-differentiated microtrabecular subtype. The imaging difference mainly existed in the part of steatohepatitis subtype. Steatohepatitis subtype HCC can be showed as "fast-in and no wash-out" characteristic in Sonazoid CEUS. Though the mechanism remains not fully clarified, this different enhancing pattern may provide a potential for the supplement of the guidelines and differential of steatohepatitis subtype HCC.

Intraarterial contrast-enhanced ultrasound to predict the short-term tumour response of hepatocellular carcinoma to Transarterial chemoembolization with Lipiodol.

BACKGROUND: Transarterial chemoembolization (TACE) is an effective locoregional therapy in hepatocellular carcinoma (HCC). However, it is difficult to predict the tumour response (TR) of TACE intraprocedurally. The aim of this study was to predict the TR after TACE (1-3 months) in HCC patients using intraprocedural intraarterial contrast enhanced ultrasound (IA-CEUS). METHODS: In this case-control study, consecutive patients who received TACE in our hospital from September 2018 to May 2019 were enrolled. IA-CEUS was performed before and after TACE. Postoperative contrast-enhanced liver MRI was performed 1-3 months after TACE as the gold standard. According to the modified Response Evaluation Criteria in Solid Tumours (mRECIST), ultrasonic manifestations were compared between the complete remission (CR) group and non-CR group by univariate and multivariate analyses. A logistic predictive model was established and validated, and its diagnostic efficiency was evaluated. RESULTS: Forty-four patients with sixty-one lesions were enrolled in the study. Multivariate analysis identified, the risk factors as a large lesion diameter (OR: 1.84; 95% confidence interval [CI]: 1.009, 3.080; P = 0.020), a larger dimension of non-enhancing area in superior mesenteric artery (SMA)-CEUS than the size in B-mode ultrasound preoperatively (OR: 3.379; 95% CI: 1.346,8.484; P = 0.010), presence of corona enhancement in hepatic artery (HA)-CEUS postoperatively (OR: 6.642; 95% CI: 1.214, 36.331; P = 0.029), and decreased corona enhancement thickness (per centimetre) postoperatively (OR: 0.025; 95% CI: 0.006,0.718; P = 0.025). The area under the receiver operating characteristic curve (AUROC) of the predictive model was 0.904 (95% CI: 0.804, 0.966; P < 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 81.08, 91.67, 85.25, 93.75, and 75.86%, respectively. Leave-one-out cross-validation (LOOCV) showed that the accuracy was 77.05%. CONCLUSIONS: Intraprocedural IA-CEUS can be used to predict the TR in HCC patients after TACE.