To assess the clinical diagnostic value of real-time contrast-enhanced ultrasound (CEUS) quantitative analysis in hepatic focal lesions initially discovered in physical examination.

Eighty-seven patients with hepatic focal lesions initially discovered by conventional color Doppler ultrasound in the physical examination at the Fourth People's Hospital of Haikou City from January 2018 to January 2021 were selected to undergo real-time CEUS examination. The results of real-time CEUS and conventional color Doppler ultrasound were analyzed based on the puncture pathology results. The time-intensity curve (TIC) was used to quantitatively analyze the real-time CEUS characteristics of the lesions and to compare the CEUS characteristics of different lesions.

A total of 101 lesions were detected in 87 patients, including 74 cases with a single lesion and 13 cases with multiple lesions. Pathological examination confirmed 57 lesions in 47 cases with benign lesions, including 21 cases of nodular hyperplasia (26 lesions), 9 cases of hepatic hemangioma (9 lesions), 3 cases of cirrhosis nodules (4 lesions), 4 cases of local inflammatory lesions (4 lesions), and 10 cases of focal fat defect (10 lesions). There were 40 cases (44 lesions) of malignant lesions, including 16 cases (18 lesions) of primary hepatocellular carcinoma, 11 cases (12 lesions) of metastatic liver cancer, and 13 cases (14 lesions) of cholangiocellular liver cancer. The diagnostic coincidence rate of color Doppler ultrasonography with the puncture pathology results for the 57 lesions in the 47 cases with benign lesions was 77.19%, and that of real-time CEUS for benign lesions was 100%; the difference was statistically significant between the two modalities (χ²=12.503, P=0.01). The diagnostic coincidence rate of color Doppler ultrasonography with puncture pathology results for the 44 malignant lesions was 61.36%, while that of real-time CEUS was 93.18%; the difference was statistically significant between the two modalities (χ²=10.935, P=0.001). The rise time, time to peak, and time to time to half value in the TIC curve were significantly later in patients with benign lesions than in those with malignant lesions (P＜0.05), while the peak intensity was significantly lower in patients with benign lesions than in those with malignant lesions (P＜0.05). The proportion of patients with blood flow Alder grade 0 and grade Ⅰ was higher in patients with benign hepatic focal lesions, while the proportion of patients with blood flow Alder grade Ⅱ and grade Ⅲ was higher in patients with malignant hepatic focal lesions; the differences between the two groups were statistically significant (P＜0.05).

Real-time CEUS can quantitatively identify benign and malignant liver lesions by assessing internal blood perfusion of hepatic focal lesions, contrast enhancement pattern, and TIC curve parameters, and can be used as an effective means for clinically determining the hepatic focal lesions detected by color Doppler ultrasound in physical examination.