To explore the value of contrast-enhanced ultrasonography (CEUS) in the screening of malignant transformation from cirrhotic nodules.

Clinical data of 25 patients who were followed up by ultrasonography in the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2016 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were males, aged 33-82 years old, with the median age of 55 years old, and with a total of 29 cirrhotic nodules. All patients were followed up regularly by ultrasonography which included conventional ultrasound and CEUS. The diameter, internal blood flow signal and CEUS features of the nodules were recorded. The diameter was compared by t test, and the CEUS features by Fisher's exact probability test. ROC curve was used for diagnostic test.

During the follow-up, 14 cirrhotic nodules turned into hepatocellular carcinoma (HCC). The diameter of malignant nodule (19±8) mm was significantly higher than (16±7) mm before malignant change (t=2.682, P<0.05). As the nodules transformed to malignancy, in the arterial phase of CEUS, signals changed gradually from equal enhancement (12/14) to hyper enhancement (13/14), and in the portal venous phase or delayed phase, it changed from equal enhancement (13/14) to low enhancement (13/14), where significant difference was observed (P<0.05). The area under the curve of AFP, conventional ultrasound and CEUS in diagnosing malignancy of cirrhotic nodules was 0.607, 0.679 and 1, respectively, where significant differences were observed (Z=4.837, 6.904, P<0.05).

In the continuous follow-up of cirrhotic nodules, CEUS can detect the hemodynamic changes in malignant nodules early, which has better diagnostic value than conventional ultrasound.