BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter...BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used.Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer.Sonazoidcontrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions,but also has great potential in the diagnosis of histological differentiation of liver cancer.AIM To assess the differentiation of hepatocellular carcinoma(HCC)by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound(CEUS).METHODS A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study.These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology.Within the cases,patients were further categorized into well-differentiated and poorlydifferentiated group.Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated,allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTS Univariate analysis showed that the absolute value of enhancement intensity(EIAV),intensity ratio(IR)and intensity difference(ID)in Kupffer phase were statistically different between the groups with different degree(P=0.015,P=0.000,P=0.000).The sensitivity and specificity were 40.2%,82.4%,80.4% and 78.1%,86.9% and 74.5%,respectively,for differentiating HCC lesions with EIAV≥56.384 dB,IR≥1.215 and ID≥9.184 dB.The area under the receiver operating characteristic curve were 0.590,0.877,0.815.There was no significant difference in the parameters of arterial phase,including peak time,initial growth time,rise time and the absolute value of peak intensity of lesions between the two groups(P>0.05).Multivariate analysis showed that the level of alphafetoprotein(AFP)and IR were risk factors for poor differentiation(P=0.001).CONCLUSION Among the parameters of Sonazoid-CEUS,IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC.Combined with preoperative AFP level,a more accurate diagnosis will be obtained.Compared with portal vein phase,Kupffer phase showed the ability to identify HCC lesions more sensitive.These findings hold significant guiding implications and reference value for clinical practice.展开更多
BACKGROUND Due to a thicker abdominal wall in some patients,ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination,precluding its ability to display or...BACKGROUND Due to a thicker abdominal wall in some patients,ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination,precluding its ability to display or clearly show the structure of a hernial sac(HS)and thereby diminishing diagnostic performance for esophageal hiatal hernia(EHH).Contrast-enhanced ultrasound(CEUS)imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.CASE SUMMARY In this case series,we report three patients with clinically-suspected EHH,including two females and one male with an average age of 67.3±16.4 years.CEUS was administered with an oral agent mixture(microbubble-based SonoVue and gastrointestinal contrast agent)and identified a direct sign of supradiaphragmatic HS(containing the hyperechoic agent)and indirect signs[e.g.,widening of esophageal hiatus,hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS,and esophagus-gastric echo ring(i.e.,the“EG”ring)seen above the diaphragm].All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy.Two lesions resolved upon drug treatment and one required surgery.The recurrence rate in follow-up was 0%.The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.CONCLUSION CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.展开更多
Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) a...Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.展开更多
BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evalu...BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evaluate the predictive value of dynamic contrast-enhanced-magnetic resonance imaging(DCE-MRI)parameters and serum biomarkers[carbohydrate antigen(CA)19-9,CA125]for determining T stage and differentiation grade in rectal cancer.METHODS We conducted a retrospective review of clinical data from 126 patients who were pathologically diagnosed with rectal cancer between January 2021 to June 2024.Each patient underwent DCE-MRI scans and serum tests for CA19-9 and CA125.Receiver operating characteristic curves were utilized to assess the diagnostic value of DCE-MRI parameters,including volume transfer constant(Ktrans),rate constant(Kep),and volume fraction of extravascular extracellular space(Ve),as well as serum biomarkers for staging and grading rectal cancer.The DeLong test algorithm was employed to evaluate differences in diagnostic performance among the various indicators.RESULTS There were statistically higher levels of Ktrans,Ve,CA19-9,and CA125 serum concentrations of patients with advanced T stages and on poorly differentiated tumors than that in patients with low stages and moderate to high differentiation(P<0.05).Combined use of Ktrans and Ve for T stage diagnosis showed an area under the curve(AUC)of 0.892[95%confidence interval(CI):0.832-0.952],which increased to 0.923(95%CI:0.865-0.981)when combined with serum biomarkers.For grades differentiation,the combined DCE-MRI parameters had an AUC of 0.883(95%CI:0.821-0.945),which rose to 0.912(95%CI:0.855-0.969)when combined with serum markers.According to the Delong test,the combined diagnostic method performed better than a single diagnostic method(P<0.05).CONCLUSION The combined application of DCE-MRI functional parameters and serum tumor markers can significantly improve the diagnostic accuracy of T staging and differentiation degree of rectal cancer,providing a new approach to improve the preoperative assessment system of rectal cancer.This combined diagnostic model has important clinical application value,but further validation is needed through large-scale multicenter studies.展开更多
BACKGROUND The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized.Furthermore,pathological changes in both Alzheimer’s disease and vascular dement...BACKGROUND The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized.Furthermore,pathological changes in both Alzheimer’s disease and vascular dementia are almost always associated with cerebral hemodynamic deficits.AIM To investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)assessment of the blood-brain barrier(BBB)in combination with relevant plasma biomarkers for mild cognitive impairment(MCI).METHODS This study selected 50 patients with non-amnestic MCI(na-MCI group),52 patients with amnestic MCI(a-MCI group),and 55 healthy elderly controls(control group).The Chinese version of the Montreal cognitive assessment(MoCA),auditory verbal learning test(AVLT),Hamilton anxiety/depression scale(HAMA/HAMD),and activity of daily living(ADL)scales were used to analyze the characteristics of mental and behavioral symptoms of patients with MCI.The DCE-MRI technique was used to assess the contrast enhancement kinetics.The Patlak model was utilized to analyze the BBB permeability(volume transfer constants).Further,fasting blood was was used to quantify plasma homocysteine(Hcy),β-amyloid protein(Aβ)40,Aβ42,human phosphorylated tau-181 protein(p-tau181),intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),and plasminogen activator inhibitor-1(PAI-1)levels,as well as serum neurofilament light chain(NFL)and glial fibrillary acidic protein(GFAP)concentrations.RESULTS The na-MCI and a-MCI groups demonstrated significantly lower MoCA and AVLT-Huashan version scores,and statistically higher HAMA,HAMD,and ADL scores compared to the control group.Moreover,the a-MCI group showed notably higher HAMA,HAMD,and ADL scores compared to the na-MCI group.Cranial MRI results revealed significant disparities in cerebral blood flow in the left and right frontal lobes,temporal lobes,hippocampi,cuneus,precuneus,parietal lobes,basal ganglia,and occipital lobes between the a-MCI and na-MCI groups.Compared to healthy controls,patients with MCI demonstrated a smaller amplitude of hippocampal contrast enhancement kinetics and a slower decay rate,indicating smaller vascular volume and increased BBB permeability.Further,Hcy,p-tau181,ICAM-1,VCAM-1,PAI-1,and NFL levels were substantially higher in the a-MCI group than in the na-MCI group,whereas the Aβ42 level was significantly lower.We did not observe any significant differences in Aβ40 and GFAP levels.CONCLUSION Patients with MCI may have experienced cerebrovascular system changes in the hippocampal region.Disorders associated with changes in cerebral blood supply may begin before pathophysiological changes are visible by imaging,which provides references for the assessment and treatment of patients with cognitive disorders.Further,DCE-MRI provides a noninvasive approach to diagnose subtle BBB leakage associated with cerebrovascular pathology.展开更多
BACKGROUND Fistulas are common complications of Crohn’s disease(CD).Gastrocolic fistulas(GFs)are rare,occult and potentially life-threatening complications.Few cases of GFs have been reported.Oral agent contrast-enha...BACKGROUND Fistulas are common complications of Crohn’s disease(CD).Gastrocolic fistulas(GFs)are rare,occult and potentially life-threatening complications.Few cases of GFs have been reported.Oral agent contrast-enhanced ultrasound(OA-CEUS)is a novel technique of ultrasound(US)for gut.Contrast agent made by Chinese yam is taken orally to dilate the lumen of the upper gastrointestinal tract.Thus,the impediment of gas inside gastrointestinal tract is removed and a good acoustic window is provided for gastroin-testinal tract scanning.This paper describes a case of GF secondary to CD detected by OA-CEUS when it was missed by endoscopy and computed tomography(CT).To our knowledge,this is the first report of GF secondary to CD detected by OA-CEUS up to date.CASE SUMMARY A 29-year-old woman with a 6-year history of CD was admitted to our hospital for abdominal pain and diarrhea for 5 months without obvious predisposing causes.Initial gastroscopy failed to show any evidence of lesions.Colonoscopy revealed multiple erosions,mucosal nodularity,linear ulcers and a cobblestone appearance.A CT scan of her abdomen showed a complex multilocular structure adherent to the greater curvature of the stomach in her left lower abdomen,with fluid,gas and significant surrounding inflammation.CT also demonstrated an abdominal abscess,which was later treated with US-guided drainage.Colonoscopy,gastroscopy and CT missed the presence of a GF.OA-CEUS was performed.A contrast agent made from Chinese yam was taken orally to dilate the lumen of the gastrointestinal tract.A good acoustic window was provided for gastrointestinal tract scanning and the impediment of gas inside the gastrointestinal tract was removed.With the aid of the“window”,a canal with hypoechoic wall was identified connecting the greater curvature of stomach to the splenic colon flexure in free sections.We also observed the hyperechoic gas flowing dynamically inside the canal.Thus,a GF was suspected.US is the first imaging modality taking GF into account.At the same time,OA-CEUS identified the site of the fistula and its two orifices.Gastroscopy was performed again,revealing a small ulcer approximately 5 mm in diameter,which was considered as an orifice.On the basis of OA-CEUS and other examinations,the patient was diagnosed with a GF secondary to CD.Then,laparoscopic exploration,partial stomach resection,transverse colostomy and abdominal abscess drainage were performed.The patient recovered uneventfully.CONCLUSION GFs are rare,occult and potentially life-threatening complications in CD.US is one of the first-line modalities to evaluate CD and its complications.OA-CEUS,a novel technique of US for gut,may be helpful in reducing the possibility of a missed diagnosis of GF.展开更多
Objective Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a significant global health issue,ranking as the sixth most diagnosed cancer and the third leading cause of cancer-related mortality.Accura...Objective Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a significant global health issue,ranking as the sixth most diagnosed cancer and the third leading cause of cancer-related mortality.Accurate and early diagnosis of HCC is crucial for effective treatment,as HCC and non-HCC malignancies like intrahepatic cholangiocarcinoma(ICC)exhibit different prognoses and treatment responses.Traditional diagnostic methods,including liver biopsy and contrast-enhanced ultrasound(CEUS),face limitations in applicability and objectivity.The primary objective of this study was to develop an advanced,lightweighted classification network capable of distinguishing HCC from other non-HCC malignancies by leveraging the automatic analysis of brightness changes in CEUS images.The ultimate goal was to create a user-friendly and cost-efficient computer-aided diagnostic tool that could assist radiologists in making more accurate and efficient clinical decisions.Methods This retrospective study encompassed a total of 161 patients,comprising 131 diagnosed with HCC and 30 with non-HCC malignancies.To achieve accurate tumor detection,the YOLOX network was employed to identify the region of interest(ROI)on both B-mode ultrasound and CEUS images.A custom-developed algorithm was then utilized to extract brightness change curves from the tumor and adjacent liver parenchyma regions within the CEUS images.These curves provided critical data for the subsequent analysis and classification process.To analyze the extracted brightness change curves and classify the malignancies,we developed and compared several models.These included one-dimensional convolutional neural networks(1D-ResNet,1D-ConvNeXt,and 1D-CNN),as well as traditional machine-learning methods such as support vector machine(SVM),ensemble learning(EL),k-nearest neighbor(KNN),and decision tree(DT).The diagnostic performance of each method in distinguishing HCC from non-HCC malignancies was rigorously evaluated using four key metrics:area under the receiver operating characteristic(AUC),accuracy(ACC),sensitivity(SE),and specificity(SP).Results The evaluation of the machine-learning methods revealed AUC values of 0.70 for SVM,0.56 for ensemble learning,0.63 for KNN,and 0.72 for the decision tree.These results indicated moderate to fair performance in classifying the malignancies based on the brightness change curves.In contrast,the deep learning models demonstrated significantly higher AUCs,with 1D-ResNet achieving an AUC of 0.72,1D-ConvNeXt reaching 0.82,and 1D-CNN obtaining the highest AUC of 0.84.Moreover,under the five-fold cross-validation scheme,the 1D-CNN model outperformed other models in both accuracy and specificity.Specifically,it achieved accuracy improvements of 3.8%to 10.0%and specificity enhancements of 6.6%to 43.3%over competing approaches.The superior performance of the 1D-CNN model highlighted its potential as a powerful tool for accurate classification.Conclusion The 1D-CNN model proved to be the most effective in differentiating HCC from non-HCC malignancies,surpassing both traditional machine-learning methods and other deep learning models.This study successfully developed a user-friendly and cost-efficient computer-aided diagnostic solution that would significantly enhances radiologists’diagnostic capabilities.By improving the accuracy and efficiency of clinical decision-making,this tool has the potential to positively impact patient care and outcomes.Future work may focus on further refining the model and exploring its integration with multimodal ultrasound data to maximize its accuracy and applicability.展开更多
Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from th...Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from the Web of Science Core Collection(SCI-EXPANDED).Only English-language articles and reviews were included.A total of 3,493 records were analyzed.VOSviewer 1.6.20 were used for bibliometric and visualization analyses,covering annual output,countries and institutions,authors,journals,keyword co-occurrence,collaboration networks,and co-citation patterns.Results:The number of publications demonstrated steady growth with acceleration after 2018,peaking in 2021 and 2023(>350 papers/year).Dietrich Christoph F.was the most productive and influential author,while Chinese scholars(e.g.,Dong Yi,Wang Wen-Ping)and institutions such as Sun Yat-sen University and Fudan University emerged as leading contributors.European journals,particularly Ultrasound in Medicine and Biology and European Radiology,showed high academic influence.Keyword analysis revealed liver cancer,especially hepatocellular carcinoma,as the dominant research theme,with expanding applications in breast,renal,and prostate tumors.Collaboration networks highlighted strong partnerships between China and Europe,whereas North American participation remained limited.Co-citation analysis indicated that a small number of highly cited studies shaped the intellectual foundation of the field.Conclusion:CEUS research in tumor diagnosis has expanded rapidly,characterized by concentrated leadership,thematic diversification,and strengthening international collaboration.With advances in artificial intelligence,super-resolution imaging,and novel contrast agents,CEUS is expected to evolve from a diagnostic tool into an integrated platform for tumor detection,treatment monitoring,and personalized cancer care.展开更多
BACKGROUND Omental torsion(OT)is a rare cause of acute abdomen,it can be difficult to diagnose preoperatively and is frequently misdiagnosed.Computed tomography(CT)is the primary imaging modality for OT.It typically s...BACKGROUND Omental torsion(OT)is a rare cause of acute abdomen,it can be difficult to diagnose preoperatively and is frequently misdiagnosed.Computed tomography(CT)is the primary imaging modality for OT.It typically shows the swirl sign.contrast-enhanced CT can better visualize the central vascular structure of the mass,thus improving the diagnostic accuracy for OT.Surgical resection is the mainstay of treatment for OT.Laparoscopy allows direct visualization of the primary torsion site and comprehensive abdominal exploration,thereby decreasing misdiagnoses.It is a safe and reliable approach for OT treatment,which offers the advantages of minimal trauma,mild postoperative pain,and rapid recovery for stylistic precision.CASE SUMMARY A 48-year-old man was admitted to our hospital due to lower right abdominal pain for the preceding 70 hours.Physical examination revealed lower right abdominal muscle strain,tenderness,and rebound pain,but no mass was palpable.Contrast-enhanced CT revealed a thickened,blurred omentum with swirling changes in the right abdomen.Laparoscopic exploration and omentectomy were performed in the emergency setting.The procedure revealed 50 mL of dark-red bloody ascites in the pelvis and twisting of the right omentum along its longitudinal axis,with a 10 cm×8 cm purple-black necrosis at the distal end.Postsurgical pathology revealed omental hemorrhage,degeneration,and necrosis.The patient had an uneventful recovery and was discharged on the fourth postoperative day.During the subsequent nine-month follow-up,he remained asymptomatic.CONCLUSION OT is a rare disease that lacks specific clinical manifestations.Abdominal contrast-enhanced CT plays a crucial role in diagnosing OT,and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.展开更多
This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnos...This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnostic modality in this study deserves merit.However,it raises interesting points of discussion:(1)Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma(PDAC),other subtypes,and neuroendocrine neoplasms(NENs),the inclusion/exclusion criteria require better clarification;(2)Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46%were grade 3;(3)Ki67 is officially recognized for grading NENs,but not for PDAC;(4)Hotspots are selected for the Ki67 grading of NENs.However,for other tumors(e.g.,breast carcinoma),the average count or hotspots are used;(5)There is no agreement for defining high-grade Ki67 cut-off for non-NENs;reports range from 10%to 50%;and(6)Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness.That notwithstanding,since the ratification of Ki67 for prognosis in NENs was based on survival outcomes,the real gold standard should be survival,instead of using Ki67 as a surrogate gold standard.In conclusion,the validation of CEUS parameters for PDAC is a work in progress.CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography,magnetic resonance imaging,positron emission tomography and endoscopic ultrasound.展开更多
Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipi...Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients.Nevertheless,the clinical manifestations of biliary complications following liver transplantation are often non-specific,making early diagnosis and timely treatment crucial for improving patient outcomes.Ultrasound is the preferred imaging method following liver transplantation.Importantly,contrast-enhanced ultrasound,with the adminis-tration of contrast agents,can improve the resolution of biliary images and enable real-time,dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues.The present article describes the normal ultra-sonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications,including anastomotic biliary strictures,non-anastomotic biliary strictures,biliary leakage,biloma,and bile sludge/bile stone.展开更多
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 cl...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 via 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(P<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(P=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.展开更多
文摘BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used.Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer.Sonazoidcontrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions,but also has great potential in the diagnosis of histological differentiation of liver cancer.AIM To assess the differentiation of hepatocellular carcinoma(HCC)by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound(CEUS).METHODS A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study.These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology.Within the cases,patients were further categorized into well-differentiated and poorlydifferentiated group.Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated,allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTS Univariate analysis showed that the absolute value of enhancement intensity(EIAV),intensity ratio(IR)and intensity difference(ID)in Kupffer phase were statistically different between the groups with different degree(P=0.015,P=0.000,P=0.000).The sensitivity and specificity were 40.2%,82.4%,80.4% and 78.1%,86.9% and 74.5%,respectively,for differentiating HCC lesions with EIAV≥56.384 dB,IR≥1.215 and ID≥9.184 dB.The area under the receiver operating characteristic curve were 0.590,0.877,0.815.There was no significant difference in the parameters of arterial phase,including peak time,initial growth time,rise time and the absolute value of peak intensity of lesions between the two groups(P>0.05).Multivariate analysis showed that the level of alphafetoprotein(AFP)and IR were risk factors for poor differentiation(P=0.001).CONCLUSION Among the parameters of Sonazoid-CEUS,IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC.Combined with preoperative AFP level,a more accurate diagnosis will be obtained.Compared with portal vein phase,Kupffer phase showed the ability to identify HCC lesions more sensitive.These findings hold significant guiding implications and reference value for clinical practice.
基金The Research Project of Sichuan Medical Association,Nos.S19080 and S18075.
文摘BACKGROUND Due to a thicker abdominal wall in some patients,ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination,precluding its ability to display or clearly show the structure of a hernial sac(HS)and thereby diminishing diagnostic performance for esophageal hiatal hernia(EHH).Contrast-enhanced ultrasound(CEUS)imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.CASE SUMMARY In this case series,we report three patients with clinically-suspected EHH,including two females and one male with an average age of 67.3±16.4 years.CEUS was administered with an oral agent mixture(microbubble-based SonoVue and gastrointestinal contrast agent)and identified a direct sign of supradiaphragmatic HS(containing the hyperechoic agent)and indirect signs[e.g.,widening of esophageal hiatus,hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS,and esophagus-gastric echo ring(i.e.,the“EG”ring)seen above the diaphragm].All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy.Two lesions resolved upon drug treatment and one required surgery.The recurrence rate in follow-up was 0%.The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.CONCLUSION CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.
文摘Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.
文摘BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evaluate the predictive value of dynamic contrast-enhanced-magnetic resonance imaging(DCE-MRI)parameters and serum biomarkers[carbohydrate antigen(CA)19-9,CA125]for determining T stage and differentiation grade in rectal cancer.METHODS We conducted a retrospective review of clinical data from 126 patients who were pathologically diagnosed with rectal cancer between January 2021 to June 2024.Each patient underwent DCE-MRI scans and serum tests for CA19-9 and CA125.Receiver operating characteristic curves were utilized to assess the diagnostic value of DCE-MRI parameters,including volume transfer constant(Ktrans),rate constant(Kep),and volume fraction of extravascular extracellular space(Ve),as well as serum biomarkers for staging and grading rectal cancer.The DeLong test algorithm was employed to evaluate differences in diagnostic performance among the various indicators.RESULTS There were statistically higher levels of Ktrans,Ve,CA19-9,and CA125 serum concentrations of patients with advanced T stages and on poorly differentiated tumors than that in patients with low stages and moderate to high differentiation(P<0.05).Combined use of Ktrans and Ve for T stage diagnosis showed an area under the curve(AUC)of 0.892[95%confidence interval(CI):0.832-0.952],which increased to 0.923(95%CI:0.865-0.981)when combined with serum biomarkers.For grades differentiation,the combined DCE-MRI parameters had an AUC of 0.883(95%CI:0.821-0.945),which rose to 0.912(95%CI:0.855-0.969)when combined with serum markers.According to the Delong test,the combined diagnostic method performed better than a single diagnostic method(P<0.05).CONCLUSION The combined application of DCE-MRI functional parameters and serum tumor markers can significantly improve the diagnostic accuracy of T staging and differentiation degree of rectal cancer,providing a new approach to improve the preoperative assessment system of rectal cancer.This combined diagnostic model has important clinical application value,but further validation is needed through large-scale multicenter studies.
文摘BACKGROUND The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized.Furthermore,pathological changes in both Alzheimer’s disease and vascular dementia are almost always associated with cerebral hemodynamic deficits.AIM To investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)assessment of the blood-brain barrier(BBB)in combination with relevant plasma biomarkers for mild cognitive impairment(MCI).METHODS This study selected 50 patients with non-amnestic MCI(na-MCI group),52 patients with amnestic MCI(a-MCI group),and 55 healthy elderly controls(control group).The Chinese version of the Montreal cognitive assessment(MoCA),auditory verbal learning test(AVLT),Hamilton anxiety/depression scale(HAMA/HAMD),and activity of daily living(ADL)scales were used to analyze the characteristics of mental and behavioral symptoms of patients with MCI.The DCE-MRI technique was used to assess the contrast enhancement kinetics.The Patlak model was utilized to analyze the BBB permeability(volume transfer constants).Further,fasting blood was was used to quantify plasma homocysteine(Hcy),β-amyloid protein(Aβ)40,Aβ42,human phosphorylated tau-181 protein(p-tau181),intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),and plasminogen activator inhibitor-1(PAI-1)levels,as well as serum neurofilament light chain(NFL)and glial fibrillary acidic protein(GFAP)concentrations.RESULTS The na-MCI and a-MCI groups demonstrated significantly lower MoCA and AVLT-Huashan version scores,and statistically higher HAMA,HAMD,and ADL scores compared to the control group.Moreover,the a-MCI group showed notably higher HAMA,HAMD,and ADL scores compared to the na-MCI group.Cranial MRI results revealed significant disparities in cerebral blood flow in the left and right frontal lobes,temporal lobes,hippocampi,cuneus,precuneus,parietal lobes,basal ganglia,and occipital lobes between the a-MCI and na-MCI groups.Compared to healthy controls,patients with MCI demonstrated a smaller amplitude of hippocampal contrast enhancement kinetics and a slower decay rate,indicating smaller vascular volume and increased BBB permeability.Further,Hcy,p-tau181,ICAM-1,VCAM-1,PAI-1,and NFL levels were substantially higher in the a-MCI group than in the na-MCI group,whereas the Aβ42 level was significantly lower.We did not observe any significant differences in Aβ40 and GFAP levels.CONCLUSION Patients with MCI may have experienced cerebrovascular system changes in the hippocampal region.Disorders associated with changes in cerebral blood supply may begin before pathophysiological changes are visible by imaging,which provides references for the assessment and treatment of patients with cognitive disorders.Further,DCE-MRI provides a noninvasive approach to diagnose subtle BBB leakage associated with cerebrovascular pathology.
基金Supported by the National Nature Science Foundation of China,No.81101061.
文摘BACKGROUND Fistulas are common complications of Crohn’s disease(CD).Gastrocolic fistulas(GFs)are rare,occult and potentially life-threatening complications.Few cases of GFs have been reported.Oral agent contrast-enhanced ultrasound(OA-CEUS)is a novel technique of ultrasound(US)for gut.Contrast agent made by Chinese yam is taken orally to dilate the lumen of the upper gastrointestinal tract.Thus,the impediment of gas inside gastrointestinal tract is removed and a good acoustic window is provided for gastroin-testinal tract scanning.This paper describes a case of GF secondary to CD detected by OA-CEUS when it was missed by endoscopy and computed tomography(CT).To our knowledge,this is the first report of GF secondary to CD detected by OA-CEUS up to date.CASE SUMMARY A 29-year-old woman with a 6-year history of CD was admitted to our hospital for abdominal pain and diarrhea for 5 months without obvious predisposing causes.Initial gastroscopy failed to show any evidence of lesions.Colonoscopy revealed multiple erosions,mucosal nodularity,linear ulcers and a cobblestone appearance.A CT scan of her abdomen showed a complex multilocular structure adherent to the greater curvature of the stomach in her left lower abdomen,with fluid,gas and significant surrounding inflammation.CT also demonstrated an abdominal abscess,which was later treated with US-guided drainage.Colonoscopy,gastroscopy and CT missed the presence of a GF.OA-CEUS was performed.A contrast agent made from Chinese yam was taken orally to dilate the lumen of the gastrointestinal tract.A good acoustic window was provided for gastrointestinal tract scanning and the impediment of gas inside the gastrointestinal tract was removed.With the aid of the“window”,a canal with hypoechoic wall was identified connecting the greater curvature of stomach to the splenic colon flexure in free sections.We also observed the hyperechoic gas flowing dynamically inside the canal.Thus,a GF was suspected.US is the first imaging modality taking GF into account.At the same time,OA-CEUS identified the site of the fistula and its two orifices.Gastroscopy was performed again,revealing a small ulcer approximately 5 mm in diameter,which was considered as an orifice.On the basis of OA-CEUS and other examinations,the patient was diagnosed with a GF secondary to CD.Then,laparoscopic exploration,partial stomach resection,transverse colostomy and abdominal abscess drainage were performed.The patient recovered uneventfully.CONCLUSION GFs are rare,occult and potentially life-threatening complications in CD.US is one of the first-line modalities to evaluate CD and its complications.OA-CEUS,a novel technique of US for gut,may be helpful in reducing the possibility of a missed diagnosis of GF.
文摘Objective Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a significant global health issue,ranking as the sixth most diagnosed cancer and the third leading cause of cancer-related mortality.Accurate and early diagnosis of HCC is crucial for effective treatment,as HCC and non-HCC malignancies like intrahepatic cholangiocarcinoma(ICC)exhibit different prognoses and treatment responses.Traditional diagnostic methods,including liver biopsy and contrast-enhanced ultrasound(CEUS),face limitations in applicability and objectivity.The primary objective of this study was to develop an advanced,lightweighted classification network capable of distinguishing HCC from other non-HCC malignancies by leveraging the automatic analysis of brightness changes in CEUS images.The ultimate goal was to create a user-friendly and cost-efficient computer-aided diagnostic tool that could assist radiologists in making more accurate and efficient clinical decisions.Methods This retrospective study encompassed a total of 161 patients,comprising 131 diagnosed with HCC and 30 with non-HCC malignancies.To achieve accurate tumor detection,the YOLOX network was employed to identify the region of interest(ROI)on both B-mode ultrasound and CEUS images.A custom-developed algorithm was then utilized to extract brightness change curves from the tumor and adjacent liver parenchyma regions within the CEUS images.These curves provided critical data for the subsequent analysis and classification process.To analyze the extracted brightness change curves and classify the malignancies,we developed and compared several models.These included one-dimensional convolutional neural networks(1D-ResNet,1D-ConvNeXt,and 1D-CNN),as well as traditional machine-learning methods such as support vector machine(SVM),ensemble learning(EL),k-nearest neighbor(KNN),and decision tree(DT).The diagnostic performance of each method in distinguishing HCC from non-HCC malignancies was rigorously evaluated using four key metrics:area under the receiver operating characteristic(AUC),accuracy(ACC),sensitivity(SE),and specificity(SP).Results The evaluation of the machine-learning methods revealed AUC values of 0.70 for SVM,0.56 for ensemble learning,0.63 for KNN,and 0.72 for the decision tree.These results indicated moderate to fair performance in classifying the malignancies based on the brightness change curves.In contrast,the deep learning models demonstrated significantly higher AUCs,with 1D-ResNet achieving an AUC of 0.72,1D-ConvNeXt reaching 0.82,and 1D-CNN obtaining the highest AUC of 0.84.Moreover,under the five-fold cross-validation scheme,the 1D-CNN model outperformed other models in both accuracy and specificity.Specifically,it achieved accuracy improvements of 3.8%to 10.0%and specificity enhancements of 6.6%to 43.3%over competing approaches.The superior performance of the 1D-CNN model highlighted its potential as a powerful tool for accurate classification.Conclusion The 1D-CNN model proved to be the most effective in differentiating HCC from non-HCC malignancies,surpassing both traditional machine-learning methods and other deep learning models.This study successfully developed a user-friendly and cost-efficient computer-aided diagnostic solution that would significantly enhances radiologists’diagnostic capabilities.By improving the accuracy and efficiency of clinical decision-making,this tool has the potential to positively impact patient care and outcomes.Future work may focus on further refining the model and exploring its integration with multimodal ultrasound data to maximize its accuracy and applicability.
文摘Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from the Web of Science Core Collection(SCI-EXPANDED).Only English-language articles and reviews were included.A total of 3,493 records were analyzed.VOSviewer 1.6.20 were used for bibliometric and visualization analyses,covering annual output,countries and institutions,authors,journals,keyword co-occurrence,collaboration networks,and co-citation patterns.Results:The number of publications demonstrated steady growth with acceleration after 2018,peaking in 2021 and 2023(>350 papers/year).Dietrich Christoph F.was the most productive and influential author,while Chinese scholars(e.g.,Dong Yi,Wang Wen-Ping)and institutions such as Sun Yat-sen University and Fudan University emerged as leading contributors.European journals,particularly Ultrasound in Medicine and Biology and European Radiology,showed high academic influence.Keyword analysis revealed liver cancer,especially hepatocellular carcinoma,as the dominant research theme,with expanding applications in breast,renal,and prostate tumors.Collaboration networks highlighted strong partnerships between China and Europe,whereas North American participation remained limited.Co-citation analysis indicated that a small number of highly cited studies shaped the intellectual foundation of the field.Conclusion:CEUS research in tumor diagnosis has expanded rapidly,characterized by concentrated leadership,thematic diversification,and strengthening international collaboration.With advances in artificial intelligence,super-resolution imaging,and novel contrast agents,CEUS is expected to evolve from a diagnostic tool into an integrated platform for tumor detection,treatment monitoring,and personalized cancer care.
文摘BACKGROUND Omental torsion(OT)is a rare cause of acute abdomen,it can be difficult to diagnose preoperatively and is frequently misdiagnosed.Computed tomography(CT)is the primary imaging modality for OT.It typically shows the swirl sign.contrast-enhanced CT can better visualize the central vascular structure of the mass,thus improving the diagnostic accuracy for OT.Surgical resection is the mainstay of treatment for OT.Laparoscopy allows direct visualization of the primary torsion site and comprehensive abdominal exploration,thereby decreasing misdiagnoses.It is a safe and reliable approach for OT treatment,which offers the advantages of minimal trauma,mild postoperative pain,and rapid recovery for stylistic precision.CASE SUMMARY A 48-year-old man was admitted to our hospital due to lower right abdominal pain for the preceding 70 hours.Physical examination revealed lower right abdominal muscle strain,tenderness,and rebound pain,but no mass was palpable.Contrast-enhanced CT revealed a thickened,blurred omentum with swirling changes in the right abdomen.Laparoscopic exploration and omentectomy were performed in the emergency setting.The procedure revealed 50 mL of dark-red bloody ascites in the pelvis and twisting of the right omentum along its longitudinal axis,with a 10 cm×8 cm purple-black necrosis at the distal end.Postsurgical pathology revealed omental hemorrhage,degeneration,and necrosis.The patient had an uneventful recovery and was discharged on the fourth postoperative day.During the subsequent nine-month follow-up,he remained asymptomatic.CONCLUSION OT is a rare disease that lacks specific clinical manifestations.Abdominal contrast-enhanced CT plays a crucial role in diagnosing OT,and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.
文摘This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnostic modality in this study deserves merit.However,it raises interesting points of discussion:(1)Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma(PDAC),other subtypes,and neuroendocrine neoplasms(NENs),the inclusion/exclusion criteria require better clarification;(2)Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46%were grade 3;(3)Ki67 is officially recognized for grading NENs,but not for PDAC;(4)Hotspots are selected for the Ki67 grading of NENs.However,for other tumors(e.g.,breast carcinoma),the average count or hotspots are used;(5)There is no agreement for defining high-grade Ki67 cut-off for non-NENs;reports range from 10%to 50%;and(6)Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness.That notwithstanding,since the ratification of Ki67 for prognosis in NENs was based on survival outcomes,the real gold standard should be survival,instead of using Ki67 as a surrogate gold standard.In conclusion,the validation of CEUS parameters for PDAC is a work in progress.CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography,magnetic resonance imaging,positron emission tomography and endoscopic ultrasound.
基金Supported by the Shenzhen Third People’s Hospital Research Fund,No.25270G1043The Basic and Applied Basic Research Foundation of Guangdong Province,No.2025A1515011934.
文摘Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients.Nevertheless,the clinical manifestations of biliary complications following liver transplantation are often non-specific,making early diagnosis and timely treatment crucial for improving patient outcomes.Ultrasound is the preferred imaging method following liver transplantation.Importantly,contrast-enhanced ultrasound,with the adminis-tration of contrast agents,can improve the resolution of biliary images and enable real-time,dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues.The present article describes the normal ultra-sonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications,including anastomotic biliary strictures,non-anastomotic biliary strictures,biliary leakage,biloma,and bile sludge/bile stone.
基金Supported by Science and Technology Program of Chinese Medicine and Integrated Chinese and Western Medicine in Guangzhou,No.20252A010001and Science and Technology Program of Guangzhou,No.2024A03J1029.
文摘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 via 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(P<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(P=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.
