THE IMPORTANCE OF CONTRAST -ENHANCED ULTRASOUND IN THE DIAGNOSIS OF DYSPLASTIC NODULES IN CIRRHOTIC PATIENTS.

Background and Aims: Dysplastic nodules are regenerative nodules but with atypical cells and they don't show clearly signs of malignancy. This study evaluates the usefulness of CEUS in the characterization of dysplastic nodules and early HCC. Methods and materials: 64 cirrhotic patients with 110 nodules no more than 2 cm were evaluated in Institute of Gastroenterology and Hepatology Iasi using CEUS with SonoVue and were analysed retrospectively. The CEUS findings were compared with clinical data and other dynamic contrast imaging such as CT and MRI Results: Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into 4 types. Type I, 47 (42.7%) nodules demonstrated simultaneous enhancement with the liver parenchyma and, therefore, the nodules appeared isoechoic to the liver throughout the arterial, portal and parenchymal phases. Type II, 29 (26.3%) nodules demonstrated delayed enhancement in the portal phase and then became isoechoic to the liver in parenchymal phase. Type III, 27 (24.5%) nodules presented delayed or simultaneous enhancement with the liver and then slight wash-out causing a hypoechoic appearance in the parenchymal phase. Type IV, 10 (9.09%) nodules presented slight enhancement with hyperechoic during arterial phase and slight wash-out with hypoechoic to the liver during the parenchymal phase. Type III and IV nodules (approximately 1/3) presented wash-out and could be mistakenly classified as malignant lesions. Conclusion: Contrast -enhanced ultrasound may be helpful in predicting the progress from dyplastic nodules to HCC. [ABSTRACT FROM AUTHOR]