Purpose: We retrospectively compared the diagnostic performance of contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computer tomography–magnetic resonance imaging (CT/MRI) for recurrent hepatocellular carcinoma (HCC) after curative treatment. Materials and methods: After curative treatment with 421 ultrasound (US) detected lesions, 303 HCC patients underwent both CEUS and CT/MRI. Each lesion was assigned a Liver Imaging Reporting and Data System (LI-RADS) category according to CEUS and CT/MRI LI-RADS. Receiver-operating characteristic (ROC) curves were computed to determine the optimal diagnosis algorithms for CEUS, CT and MRI. The diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC) were compared between CEUS and CT/MRI. Results: Among the 421 lesions, 218 were diagnosed as recurrent HCC, whereas 203 lesions were diagnosed as benign. In recurrent HCC, CEUS detected more arterial hyperenhancement (APHE) and washout than CT and more APHE than MRI. CEUS yielded better diagnostic performance than CT (AUC: 0.981 vs. 0.958) (p= 0.024) comparable diagnostic performance to MRI (AUC: 0.952 vs. 0.933) (p> 0.05) when using their optimal diagnostic criteria. CEUS missed 12 recurrent HCCs, CT missed one, and MRI missed none. The detection rate of recurrent HCC on CEUS (94.8%, 218/230) was lower than that on CT/MRI (99.6%, 259/260) (p= 0.001). Lesions located on the US blind spots and visualization score C would hinder the ability of CEUS to detect recurrent HCC. Conclusion: CEUS demonstrated excellent diagnostic performance but an inferior detection rate for recurrent HCC. CEUS and CT/MRI played a complementary role in the detection and characterization of recurrent HCC.
目的：本研究旨在回顾性比较超声造影（CEUS）与增强计算机断层扫描-磁共振成像（CT/MRI）对根治性治疗后复发性肝细胞癌（HCC）的诊断效能。材料与方法：421例经超声（US）检出病灶并接受根治性治疗的HCC患者中，303例同时接受了CEUS和CT/MRI检查。根据CEUS和CT/MRI的肝脏影像报告与数据系统（LI-RADS）标准对每个病灶进行分类。通过绘制受试者工作特征（ROC）曲线确定CEUS、CT及MRI的最佳诊断算法，并比较CEUS与CT/MRI的诊断准确率、敏感性、特异性及曲线下面积（AUC）。结果：421个病灶中，218个确诊为复发性HCC，203个为良性病灶。对于复发性HCC，CEUS检测到的动脉期高增强（APHE）和廓清现象多于CT，APHE检出率高于MRI。采用最佳诊断标准时，CEUS的诊断效能优于CT（AUC：0.981 vs. 0.958）（p=0.024），与MRI相当（AUC：0.952 vs. 0.933）（p>0.05）。CEUS漏诊12例复发性HCC，CT漏诊1例，MRI无漏诊。CEUS对复发性HCC的检出率（94.8%，218/230）低于CT/MRI（99.6%，259/260）（p=0.001）。位于超声盲区或可视化评分C级的病灶会影响CEUS对复发性HCC的检出能力。结论：CEUS对复发性HCC具有优异的诊断效能，但检出率较低。CEUS与CT/MRI在复发性HCC的检出与特征分析中具有互补作用。
Complementary Role of CEUS and CT/MR LI-RADS for Diagnosis of Recurrent HCC
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