Predictive Value of Contrast-enhanced Ultrasound for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection

This retrospective study aimed to use preoperative and contrast-enhanced ultrasound (CEUS) factors to assess and reveal risk factors of early recurrence (ER) in patients with hepatocellular carcinoma (HCC). We enrolled 141 patients with primary HCC who had undergone surgical resection. The assessment of the CEUS scan includes (a) the maximum diameter of the lesion, (b) the tumor echogenicity of gray-scale ultrasound (US), (c) the morphology of the tumor, (d) the margin of the tumor, (e) the peripheral hypoechoic halo, (f) tumor necrosis, (g) nutritional arteries shown by tumors, (h) ultrasonography for diagnosis of cirrhosis, and (i) the timer on the US screen displayed the time elapsed from the saline flush and was used to determine time to washout. According to the degree of the phase, the washout rate is divided into four grades, namely, levels 1 to 4. ER is defined as the time between resection and recurrence within 12 months after surgery. Risk factors for ER HCC were analyzed. Predictors of ER on a univariate logistic regression analysis in CEUS are size, washout rate, morphology, center necrosis, and feeding artery appearing in the tumor. Multivariate analysis results indicated that feeding artery, microvascular invasion (MVI), and washout rate were independent risk factors for ER. The relative high risk of ER for washout rate 1, 2, 3, and 4 were 29.3%, 43.2%, 53.1%, and 71.4%, respectively. The appropriateness of hepatectomy in the treatment of single lesion HCC should be carefully considered when the washout rate was 4.