Correlation Between CEUS Identification of Nodular HPD on CE-MRI and Hepatic Malignant Lesions

Hepatic malignant tumors, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and liver metastases, represent a significant global health burden due to their high incidence and mortality rates. With advancements in imaging techniques, the detection of hepatic perfusion disorders (HPD) in high-risk populations during screening and follow-up has increased. However, the imaging characteristics of HPD lack distinct heterogeneity, and certain benign lesions-such as post-treatment inflammatory reactions, arterioportal shunts, hyperplastic nodules, focal fat deposition, or fibrotic nodules-may exhibit overlapping imaging features with malignant lesions, posing a challenge for accurate diagnosis.

Contrast-enhanced magnetic resonance imaging (CE-MRI) is a key modality for evaluating hepatic nodules. However, it has limitations in differentiating non-typical enhancement patterns of lesions, such as metastases with minimal microvascular invasion, as well as non-specific nodules in cirrhotic backgrounds. Contrast-Enhanced Ultrasound (CEUS), with its unique ability to provide real-time dynamic assessment of tumor perfusion, is increasingly recognized as a valuable tool for hepatic lesion evaluation. Compared to CE-MRI, CEUS offers superior temporal resolution and lower costs, particularly in early post-treatment efficacy assessment, hemodynamic evaluation, and differentiation of residual viable tumor tissue from post-treatment changes. Moreover, ultrasound-MRI fusion imaging enhances the detection of small hepatic lesions, while CEUS quantitative analysis allows for the evaluation of tumor microvascular parameters to predict early malignant transformation. These advancements provide a more reliable approach for identifying malignant HPD using CEUS-based techniques.

This multicenter, prospective study aims to integrate ultrasound-MRI fusion imaging and CEUS quantitative analysis to improve the precise identification of early malignant lesions within nodular HPD detected on CE-MRI. Additionally, this study seeks to establish high-level evidence supporting the use of CEUS with ultrasound-MRI fusion for accurate localization and characterization of malignant lesions. Ultimately, the findings will contribute to the optimization of surveillance strategies for high-risk populations, including individuals at risk for hepatocellular carcinoma and other malignant tumors.