Abstract
AimTo verify if detailed analysis of temporal enhancement patterns on contrast enhanced ultrasound (CEUS) may help differentiate intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in cirrhosis.MethodsThirty three ICC and fifty HCC in cirrhosis were enrolled in this study. The contrast kinetics of ICC and HCC was analyzed and compared.ResultsStatistical analysis did not reveal significant difference between ICC and HCC in the time of contrast first appearance and arterial peak maximum time. ICC displayed much earlier washout than that of HCC (47.93±26.45 seconds vs 90.86±31.26 seconds) in the portal phase, and most ICC (87.9%) showed washout before 60 seconds than HCC (16.0%). Much more ICC (78.8%) revealed marked washout than HCC (12.0%) while most HCC (88.0%) showed mild washout or no washout in late part of the portal phase (90–120 seconds). Twenty six out of thirty three ICC (78.8%) demonstrated both early washout(<60seconds) and marked washout in late part of the portal phase, whereas, only six of fifty HCC (12.0%)showed these temporal enhancement features (p = 0.000).When both early washout and marked washout in the portal phase are taken as diagnostic criterion for ICC, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78.8%,88.0%,81.3%,86.3%,and 84.3% respectively by CEUS.ConclusionsAnalysis of detailed temporal enhancement features on CEUS is helpful differentiate ICC from HCC in cirrhosis.If a nodule in cirrhotic liver displays hyper-enhancement in the arterial phase followed by early and marked washout in the portal phase, the nodule is highly suspicious of ICC rather than HCC.
Highlights
Intrahepatic peripheral cholangiocarcirnoma (ICC) constitutes the second most common primary liver malignant tumor in cirrhotic patients, accounting for 1%–3% of newly developed tumors[1,2],and the incidence of ICC appears raising,especially in Western countries [3]
Differentiation between them is essential for surgical planning and prognosis assessment because ICC and hepatocellular carcinoma (HCC) have different biological behaviour and prognosis[6,7].The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB)defined typical contrast enhanced ultrasound (CEUS) vascular pattern of ICC as rim-like enhancement/non-enhancement in arterial phase followed by hypo/non-enhancement during the portal and late phases [8], but these recommendations are based on studies in which most patients did not have underlying cirrhosis
ICC and HCC on cirrhosis in which CEUS had been performed in our hospital between January 2005 and February 2014.The following inclusion criteria were applied: (A) Histologically proven liver cirrhosis by representative resections or biopsies from the liver parenchyma; (B) The diagnosis of ICC and HCC had to be pathologically proven; (C) Real-time CEUS was performed for diagnosis within less than a month before surgical operation or biopsy
Summary
Intrahepatic peripheral cholangiocarcirnoma (ICC) constitutes the second most common primary liver malignant tumor in cirrhotic patients, accounting for 1%–3% of newly developed tumors[1,2],and the incidence of ICC appears raising,especially in Western countries [3]. Only three retrospective studies including a relatively limited number of patients have described the ICC enhancement pattern at CEUS and the associated risk of misdiagnosis with HCC [9,10,11]. These studies showed that CEUS was at risk of misdiagnosis of ICC for HCC in about 47.6%-68.8% patients.
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