Clinical value of contrast-enhanced ultrasound in early diagnosis of hepatocellular carcinoma.

[BACKGROUND] Contrast-enhanced ultrasound (CEUS) offers valuable reference data for the early diagnosis of hepatocellular carcinoma (HCC) through dynamic enhancement patterns and quantitative analysis.

[AIM] 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.

[METHODS] 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 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.

[RESULTS] 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 ( < 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 ( = 0.032).

[CONCLUSION] 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.