Abstract
ObjectivesThe aim of this study was to investigate the role of contrast-enhanced ultrasound (CEUS) in differentiating hepatocellular carcinoma (HCC) vs. intrahepatic cholangiocarcinoma (ICC) and primary liver cancer vs. benign liver lesions for surgical decision making.MethodsData from 328 patients (296 primary liver cancer patients: 232 HCC and 64 ICC patients and 32 benign hepatic lesion patients) who underwent hepatectomy at our center were retrospectively collected from 2010 to 2015. Conventional ultrasound (US) and CEUS were performed for all patients before hepatectomy. Enhancement patterns in CEUS were classified and compared for HCC vs. ICC and for primary liver cancer vs. benign lesions.ResultsPrimary liver cancer and hepatic benign lesions could be distinguished by CEUS in different phases. The most obvious differences were in the portal and delayed phases, in which benign lesions could still show hyperenhancement (46.9% vs. 0.0% and p < 0.001 in the portal phase; 43.7% vs. 0.0% and p < 0.001 in the delayed phase). For differentiating HCC and ICC, our results revealed that HCC and ICC displayed different enhancement patterns in the arterial phase (p < 0.001) and the portal phase (p < 0.001). In the subgroup analyses, both HCC and ICC showed a high rate of homogeneous hyperenhancement during the arterial phase when tumors were ≤5 cm (87.2% vs. 64.0% and p = 0.008) or the Ishak score was ≥5 (75.8% vs. 42.9% and p = 0.023), although there was statistical difference. However, during the portal phase, ICC > 5 cm showed significantly more frequent hypoenhancement (92.3% vs. 54.5% and p < 0.001) and less isoenhancement (7.7% vs. 45.5% and p < 0.001) than HCC; additionally, during the portal phase, there was no statistical difference in the enhancement patterns of ICC with different hepatic backgrounds.ConclusionsTumor size and hepatic background should be taken into consideration when distinguishing HCC and ICC before surgery. However, CEUS is a helpful tool for differentiating malignant and benign hepatic lesions. For patients who require surgical treatment, CEUS may help with surgical decision making.
Highlights
Contrast-enhanced ultrasound (CEUS) has been utilized to characterize hepatic lesions for over 10 years because its offers a diagnostic accuracy range comparable to that of contrast computed tomography (CT) and contrast magnetic resonance imaging (MRI) [1]
Tumor size and hepatic background should be taken into consideration when distinguishing hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) before surgery
For patients who require surgical treatment, CEUS may help with surgical decision making
Summary
Contrast-enhanced ultrasound (CEUS) has been utilized to characterize hepatic lesions for over 10 years because its offers a diagnostic accuracy range comparable to that of contrast computed tomography (CT) and contrast magnetic resonance imaging (MRI) [1]. As previous studies have demonstrated [3,4,5,6], imaging features reflect pathologic information, which could be a reason why imaging every phase with CT, MRI or CEUS can help to differentially diagnose suspicious hepatic lesions. The use of CEUS as a technique for diagnosing hepatic nodules in cirrhosis was dropped from the updated AASLD guidelines in 2011 [9] and from the guidelines of the European Association for the Study of the Liver (EASL) in 2012 [10]. Several studies analyzed the use of CEUS to differentiate ICC from HCC according to tumor size and hepatic background [8, 11,12,13,14]; few of these studies discussed the size of the nodules and cirrhosis, and the number of patients in those studies was relatively small. Comparisons of primary liver cancer and benign tumors and the application of CEUS for treatment aspects were rarely mentioned
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