Abstract: Objective To investigate the efficacy of contrast-enhanced ultrasound (CEUS) in diagnosing canceration nodules (CN) in cirrhotic liver and small hepatocellular carcinoma (sHCC). Methods One hundred and twenty-seven patients with liver cirrhotic nodules from February 2018 to February 2020 were included as the research objects. In all patients pathological evaluation of the liver nodules achieved by ultrasound-guided biopsy were recorded as the gold standard, including CN, low-grade dysplastic nodules (LGDN), high-grade dysplastic nodules (HGDN) and sHCC. The characteristics of CEUS in different pathological stages were compared. The accuracy of CEUS in judging the pathological type of CN canceration and sHCC were analyzed. Results The 127 patients were followed up for 8 to 32 months with an average period of time of (16.6±5.4) months. The liver biopsy results showed that there were 38 cases of CN, 32 cases of LGDN, 26 cases of HGDN and 31 cases of sHCC among the 127 patients. The time to peak (TTP)of CN, LGDN, HGDN and sHCC groups were (44.6±13.2)s, (38.4±10.9)s, (30.5±9.0)s and (23.8±8.5)s, respectively(P<0.05), the mean transit time (MTT) were (141.0±35.4)s, (130.4±29.8)s, (117.3±30.2)s and (109.5±27.4)s, P<0.05, the rise time (RT) were (40.6±11.2)s, (35.4±7.7)s, (31.2±9.3)s and (22.1±8.7)s, P<0.05. The CEUS examination showed that the CN perfusion mode (31 cases in stage IV, 5 cases in stage V, 2 cases in stage VI and 1 case in stage VII), LGDN (4 cases in stage V, 24 cases in stage VI, 3 cases in stage VII and 1 case in stage VIII), HGDN(23 cases in stage VI and 3 cases in stage VII), sHCC (24 cases in stage 1, 2 cases in stage II and 5 cases in stage III). The difference of CEUS perfusion mode were statistically significant in different pathological stages (P<0.05). The ROC analysis showed that the TTP (AUC=0.642, 95%CI=0.526～0.758), MTT (AUC=0.651, 95%CI=0.536～0.766) and RT (AUC=0.716, 95%CI=0.606～0.826) had certain application value in judging sHCC (P<0.05). The AUC of sHCC was 0.802 of joint prediction probability of TTP, MTT and RT (SE=0.047, 95%CI=0.710～0.895, P<0.05), the sensitivity was 0.935 and the specificity was 0.561. Conclusion The CEUS can effectively identify the pathological process of CN, and the CEUS examination is helpful for the early detection of sHCC.

Key words: Contrast enhanced ultrasound, Cirrhotic nodules, Canceration risk, Small hepatocellular carcinoma