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. 2015 Dec;4(4):241-52.
doi: 10.1159/000367738. Epub 2015 Oct 21.

Contrast-Enhanced Ultrasound for the Characterization of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Guang-Jian Liu  1 , Wei Wang  1 , Ming-De Lu  2 , Xiao-Yan Xie  1 , Hui-Xiong Xu  1 , Zuo-Feng Xu  1 , Li-Da Chen  1 , Zhu Wang  1 , Jin-Yu Liang  1 , Yang Huang  1 , Wei Li  1 , Jin-Ya Liu  1
Affiliations

Contrast-Enhanced Ultrasound for the Characterization of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Guang-Jian Liu et al. Liver Cancer. 2015 Dec.

Abstract

Purpose and methods: The ability of contrast-enhanced ultrasound (CEUS) to differentiate between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is still controversial. We reviewed the CEUS imaging of 819 patients (HCC=546, ICC=273) with an established pathological diagnosis. The enhancement patterns of lesions and the diagnostic performance of CEUS were analyzed.

Results: Arterial hyperenhancement followed by washout was observed in 92.3% (504/546) of the HCC lesions and 85.7% (234/273) of the ICC lesions on CEUS (p<0.05). Additionally, the ICCs presented contrast washout much earlier than the HCCs, with an average time of 27.5 seconds after injecting the contrast agent compared with 70.1 seconds for the HCCs (p<0.05). Peripheral rim-like enhancement was observed in 68.5% (187/273) of the ICCs, which was significantly more common than that in the HCCs (2.0%, 11/546) (p<0.05). When using arterial hyperenhancement with a washout phase later than 43 seconds after injecting the contrast agent and with no peripheral rim-like enhancement as the diagnostic criteria for HCC ≤5 cm in diameter, the area under the curve was 0.808, with 64.1% sensitivity, 97.4% specificity and 73.6% accuracy.

Conclusions: Although ICC may show the typical enhancement pattern of HCC on CEUS, peripheral rim-like enhancement and quick contrast washout show high efficiency in the differentiation of HCC from ICC.

Keywords: Contrast-enhanced ultrasound; Differentiation; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma.

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Figures

Fig. 1
Fig. 1
Contrast distribution patterns of HCC and ICC on CEUS. a HCC in a 56-year-old man with cirrhosis showed homogeneous hyperenhancement in the arterial phase at 26 seconds. b HCC in a 42-year-old man with cirrhosis showed heterogeneous hyperenhancement in the arterial phase at 30 seconds. c ICC in a 63-year-old women without cirrhosis showed peripheral rim-like enhancement in the arterial phase at 21 seconds.
Fig. 2
Fig. 2
1. HCC of 7.9 cm in diameter in a 42-year-old man who presented was a typical CEUS pattern. a Arterial phase image taken at 24 seconds after UCA injection: The lesion presented heterogeneous hyperenhancement with center necrosis and irregular intra-nodular vessels. b Portal phase image at 86 seconds: The lesion showed hypoenhancement with a clear margin. The enhancement duration lasted for 49 seconds. From 11 seconds it began to show hyperenhancement and at 60 seconds it began to show contrast washout. 2. ICC of 6.8 cm in diameter in a 58-year-old man who presented with a typical CEUS pattern. c Arterial phase image taken at 16 seconds after UCA injection: The lesion presented a characteristic peripheral rim-like hyperenhancement. d Portal phase image at 42 seconds: The irregular rim-like enhancement showed clear contrast washout. The enhancement duration lasted for 27 seconds. From 12 seconds it began to show hyperenhancement and at 39 seconds it began to show contrast washout.
See this image and copyright information in PMC

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