Abstract: Objective The aim of this study was to explore the diagnostic performance of contrast-enhanced ultrasound (CEUS) in determining qualitatively intrahepatic space-occupying lesions in patients with hepatitis B liver cirrhosis (LC). Methods 521 patients with hepatitis B LC were admitted to our hospital between January 2020 and January 2022, and all underwent liver biopsy and CEUS. The intrahepatic space-occupying lesions were evaluated by liver imaging reporting and data system (LI-RADS).The diagnostic efficacy of LI-RADS was evaluated by the area under receiver operating characteristic curve (AUROC). Results Out of the 521 patients with LC in our series, the liver histopathological examination showed hepatocellular carcinoma (HCC) in 96 cases, focal nodular hyperplasia of liver (FNHL) in 150 cases, hepatic hemangioma (HH) in 162 cases, hepatic cysts in 63 cases and local fatty liver in 50 cases; the diagnosis of the LI-RADS based on the CEUS evaluation found type I lesions in 248 cases (HH in 145 cases, hepatic cysts in 63 cases and local fatty liver in 40 cases), type II lesions in 140 cases (all was FNHL), type III in 22 cases (FNHL in 18 cases and HCC in 4 cases), type IV lesions in 39 cases (FNHL in 6 cases, HH in 7 cases and HCC in 26 cases), and type V lesions in 72 cases (FNHL in 6 cases and HCC in 66 cases); the AUROC was 0.84(95%CI:0.78-0.89), with the sensitivity (Se), specificity (Sp), positive predicting value (PPV) and negative predicting value (NPV) of 68.8%, 98.6%, 91.7% and 93.3%, respectively, when the type V lesions was determined by LI-RADS, much superior to type IV lesions judged by LI-RADS [0.62(95%CI:0.55-0.69), 27.1%, 96.9%, 66.7% and 85.5%] or to type III lesions judged by LI-RADS [0.50(95%CI:0.44-0.56), 4.2%, 95.8%, 18.2% and 81.6%, P＜0.05]. Conclusion The diagnostic performance on type I, II and V intrahepatic lesions by liver imaging reporting and data system based on the contrast-enhanced ultrasound is excellent, but as for type III and IV lesions, the qualitative diagnosis might be difficult and should be made comprehensively.

Key words: Hepatocellular carcinoma, Liver cirrhosis, Contrast-enhanced ultrasound, Liver imaging reporting and data system, Diagnosis