Abstract: Objective This study aimed to evaluate the application value of enhanced perfusion scanning parameters and serum levels of High Mobility Group A2 (HMGA2) and Protein Induced by Vitamin K Absence or Antagonist-Ⅱ (PIVKA-Ⅱ) in the differential diagnosis between cirrhotic nodules and primary small hepatocellular carcinoma (HCC). Methods A total of 103 patients with liver cirrhosis treated at Zhoukou Central Hospital from March 2021 to March 2024 were selected for this study. Based on histopathological examination, patients were divided into a cirrhotic nodule group (n=75) and a primary small HCC group (n=28). Enhanced perfusion scanning was used to assess the hemodynamic characteristics of hepatic lesions. Serum levels of HMGA2 and PIVKA-Ⅱ were measured, and their correlation was analyzed. The efficacy of HMGA2 and PIVKA-Ⅱ in differential diagnosis was assessed using receiver operating characteristic (ROC) curve analysis. Results The age of patients in the nodule group was significantly lower than that in the HCC group (35.7±10.4 years vs. 62.5±12.7 years; P<0.05). Serum levels of HMGA2 and PIVKA-Ⅱ were significantly higher in the HCC group than those in the nodules group (HMGA2: 57.53±11.50 mg/L vs. 37.74±8.24 mg/L; PIVKA-Ⅱ: 86.03±21.82 mAU/mL vs. 25.27±10.64 mAU/mL; P<0.05). Blood flow, hepatic arterial perfusion, hepatic arterial fraction, and blood volume were significantly lower in the HCC group compared to the nodule group (blood flow: 186.85±14.27 mL/min·100 g vs. 202.17±15.42 mL/min·100 g; hepatic arterial perfusion: 37.92±4.87 mL/min·100 g vs. 52.58±5.61 mL/min·100 g; hepatic arterial fraction: 0.20±0.03 vs. 0.28±0.04; blood volume: 165.27±18.53 mL/100 g vs. 175.63±20.47 mL/100 g; P<0.05). Pearson correlation analysis showed a negative correlation between HMGA2 and blood flow, hepatic arterial perfusion, hepatic arterial fraction, blood volume (r=-0.439, -0.624, -0.532, -0.220; P<0.05 respectively), and similar negative correlation was found for PIVKA-Ⅱ (r=-0.378, -0.704, -0.665, -0.307; P<0.05 respectively). ROC curve analysis indicated that the combined use of HMGA2 and PIVKA-Ⅱ had high diagnostic value, with an AUC of 0.969, sensitivity of 96.4%, and specificity of 96.0%. Conclusion Enhanced perfusion scanning parameters combined with serum HMGA2 and PIVKA-Ⅱ effectively differentiate between cirrhotic nodules and HCC, providing important information for early diagnosis and treatment selection.

Key words: Enhanced perfusion scanning, HMGA2, PIVKA-Ⅱ, Cirrhotic nodules, Primary small hepatocellular carcinoma, Differential diagnosis