Abstract: Objective The aim of this study was to investigate diagnostic performance of sonazoid contrast-enhanced ultrasound (CEUS) and serum alpha fetoprotein(AFP) and prothrombin induced by the absence of vitamin K or antagonist-II (PIVKA II) levels in determining quality of focal liver lesions (FLL). Methods 80 patients with FLL were admitted to our hospital between May 2019 andJuly 2024, and all of them underwent liver biopsies and sonazoid CEUS examination.Serum AFP and PIVKA-II levels were measured by chemiluminescence immunoassay. Receiver operating characteristic (ROC) curves wereplotted to explore the diagnostic efficacy of sonazoid CEUS and serum AFP and PIVKA-II level combination in judging the quality of FLL. Results Of the 80 patients with FLL, liver pathological examination proved hepatocellular carcinoma(HCC)in 43 cases, focal nodular hyperplasia (FNH) in 13 cases, cirrhotic nodule in 19 case and inflammtory pseudotumor in 5 cases; serum AFP and PIVKA-Ⅱ levels in malignant group were (710.1±213.0)ng/ml and (56.0±18.0) mAU/ml, both significantly higher than [(8.4±1.5)ng/ml and (28.3±6.3)mAU/ml, respectively,P＜0.05] in benign group; CEUS diagnosed benign lesions in 29 cases and malignant ones in 51 cases; of51 patients with malignant lesions diagnosed by CEUS, the percentages of fast-in at arterial phase, fast-out at portal phase and complete clearance at delayed phase in malignant group were86.3%, 76.5% and 88.2%, all much higher than 31.0%, 0.0% and 0.0%(P＜0.05) in benign group; the AUC was 0.932(95%CI:0.853-0.976), with sensitivity of 100.0% and specificity of 86.5%, when serum AFP=400 ng/ml and PIVKA-Ⅱ=55 mAU/ml were respectively set as the cut-off-value and combined with CEUS in determining the quality of FLL, much superior to any parameter did alone(P＜0.05). Conclusion Sonazoid CEUS and serum AFP and PIVKA-II level combination isgenerally accuracy in diagnosing quality of focal liver lesions, which might help clinicians make an appropriate intervention as early as possible.

Key words: Focal liver lesion, Sonazoid contrast-enhanced ultrasound, Alpha fetoprotein, Prothrombin induced by the absence of vitamin K or antagonist-II, Diagnosis