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Review
. 2024 Feb 27;24(96):20240005.
doi: 10.15557/jou.2024.0005. eCollection 2024 Feb.

Diagnosis of intrahepatic cholangiocarcinoma with CEUS

Giancarlo Gismondo Velardi  1 , Matilde Lico  1 , Angela Teti  1 , Rosario Maccarone  1 , Giuseppe Casuscelli  1 , Letterio Militano  1 , Ilaria Vittoria Trecroci  1 , Maria Mendicino  2 , Antonello Parlati  2 , Adele De Caridi  2 , Giuseppe Loria  2 , Saverio Loria  3 , Sveva Loria  4 , Denise Gambardella  5 , Manfredo Tedesco  5 , Francesca Frosina  6 , Pierluigi Falco  7 , Francesco Loria  1
Affiliations
Review

Diagnosis of intrahepatic cholangiocarcinoma with CEUS

Giancarlo Gismondo Velardi et al. J Ultrason. .

Abstract

Intrahepatic cholangiocarcinoma (ICC) is a rare, heterogeneous, highly lethal tumor of the biliary tract. Due to the lack of effective treatments, an early identification of ICC is essential to achieve the best outcome in terms of therapy and prognosis aiming for a curative intent. ICC may arise on a normal liver or with an underlying liver disease, making the diagnosis more difficult and complex. Contrast-enhancement ultrasound (CEUS) is an accurate procedure able to detect ICC-specific contrast vascular pattern, and thus facilitating the correlation between radiological and histopathological findings with high specificity and sensitivity. CEUS has been shown to have a high diagnostic potential in the diagnosis of ICC thanks to the possibility of studying in real time the intralesional microcirculation and evaluating the precocity of the enhancement of the lesion during the arterial phase. All these features allow to differentiate the ICC from hepatocarcinoma (HCC) with high sensitivity and specificity. Furthermore, CEUS is a rapid, non-invasive, non-nephrotoxic or non-allergenic tool. The only limitations CEUS may have are related to the disease site and patient characteristics (obesity) and compliance, including the operator's experience. A clinical evaluation of the patient, together with tumor markers and biochemical tests assessment, to differentiate ICC from HCC are highly suggested.

Keywords: contrast-enhanced ultrasound; early diagnosis; intrahepatic cholangiocarcinoma; liver.

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Conflict of interest statement

Conflicts of interest The authors do not report any financial or personal connections with other persons or organizations which might negatively affect the contents of this publication and/or claim authorship rights to this publication.

Figures

Fig. 1.
Fig. 1.
A. B-Mode ultrasound shows slightly hyperechogenic, inhomogeneous ecostructure nodule with slightly rough and irregular hypoechoic margins; B. Arterial phase (20 s): rim-like peripheral hyperenhancement with central microcirculation; C. Portal phase (70 s): the nodule has peripheral wash-out with central hypoenhancement; D. Late phase: ICC nodule presenting hypoenhancement
Fig. 2.
Fig. 2.
A. B-Mode ultrasound shows an unevenly hypoechoic nodule at finely drafted irregular margins, showing no intralesional vascularization at color-Doppler; B. Arterial phase (22 s); C. Portal phase (65 s): slight persistence of peripheral enhancement with intralesional contrast agent wash-out; D: Late phase: nodule hypoenhancement
Fig. 3.
Fig. 3.
A. B-Mode ultrasound shows a homogenous isohypoechoic nodule with thin peripheral hypoechoic capsule; B. Arterial phase (17 s): complete and homogeneous hyperenhancement of the nodule; nodule presents in portal phase (C, 70 s) and late (D) hypoenhancement
Fig. 4.
Fig. 4.
CEUS in a typical HCC. A. B-Mode ultrasound shows an isohyperechoic nodule (arrow); B. Arterial phase (30 s): complete and homogeneous hyperenhancement of the nodule (arrow); C. In the portal phase (90 s), the nodule appears slightly hypovascular (arrow); D. In the late phase (180 s), the nodule appears completely hypovascular (arrow)
Fig. 5.
Fig. 5.
A. B-Mode ultrasound shows a circumscribed isodense polypoid overhang in the context of the biliary intrahepatic pathway at the seventh segment (arrow); B. In the arterial phase, there is a partial capsular peripheral enhancement (arrow); C. In the portal phase, the intraductal ICC nodule presents tenuous hyperenhancement (arrow); D. In the late phase, the nodule presents hypoenhancement (arrow)
See this image and copyright information in PMC

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