Abstract: Objective To analyze the value of contrast-enhanced ultrasonography in the differential diagnosis of alpha-fetoprotein (AFP) negative and positive hepatocellular carcinoma (HCC) patients.Methods Between January 2017 and December 2019,there were 90 HCC patients (62 males and 28 females) enrolled,with an average age of (53.1±7.9) years.Measurement data (±s) were analyzed by t-test.Count data (%) were analyzed by chi-square test.Results There were 56 patients in AFP-positive (AFP ≥ 20 g/L) group with a total of 74 lesions,34 patients in AFP-negative (AFP <20 g/L) group with a total of 38 lesions.The incidence of hepatitis B virus infection in AFP-negative group (24/34,70.6%) was significantly lower than that in AFP-positive group (51/56,91.1%,P<0.05).There were 29 (85.3%) cases with single focus,5 (14.7%) cases with multiple foci in AFP-negative group,and 37 (66.1%) cases with single focus,19 (33.9%) cases with multiple foci in AFP-positive group.Difference was statistical between the 2 groups (P<0.05).The diameter of lesions in AFP-negative group [(2.9±1.4) cm] was significantly shorter than that in AFP-positive group [(3.8±2.5) cm,P<0.05].In arterial phase,there was no significant difference in the incidences of hypoechoic,isoechoic or hyperechoic lesions between AFP negative and positive groups.In portal phase,there were 9 (23.7%) cases of hypoechoic lesions,25 (65.8%) cases of isoechoic lesions,4 (10.5%) cases of hyperechoic lesions in AFP-negative group,and 44 (59.5%) cases of hypoechoic lesions,30 (40.5%) cases of isoechoic lesions,no cases of hyperechoic lesions in AFP-positive group.Differences were statistically significant (P<0.05).In delayed phase,there were 22 (57.9%) cases of hypoechoic lesions,16 (42.1%) cases of isoechoic lesions,no cases of hyperechoic lesions in AFP-negative group,and 58 (78.4%) cases of hypoechoic lesions,16 (21.6%) cases of isoechoic lesions,no cases of hyperechoic lesions in AFP-positive group.Differences were statistically significant (P<0.05).The peak time in AFP-negative group [(29.0±4.1) s] was significantly longer than that in AFP-positive group [(23.7±3.6) s,P<0.05].The retention time in AFP-negative group [(90.4±7.1) s] was significantly shorter than that in AFP-positive group [(98.7±6.7) s,P<0.05].The area under the receiver operating characteristic curve in AFP-negative group (2158.4±210.6) was significantly less than that in AFP-positive group [(2480.2±215.6),P<0.05].However,the arrival time has no significant difference between the 2 groups (P>0.05).Conclusion In contrast-enhanced ultrasound imaging,both AFP negative and positive HCC patients show fast-in and fast-out enhancement,especially in AFP-positive patients.Contrast-enhanced ultrasound is helpful in distinguishing AFP-negative and AFP-positive HCC.

Key words: Primary hepatocellular carcinoma, Contrast-enhanced ultrasonography, Alpha-fetoprotein