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01.03.2010 | Ultrasound

Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound

verfasst von: Li-Da Chen, Hui-Xiong Xu, Xiao-Yan Xie, Xiao-Hua Xie, Zuo-Feng Xu, Guang-Jian Liu, Zhu Wang, Man-Xia Lin, Ming-De Lu

Erschienen in: European Radiology | Ausgabe 3/2010

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Abstract

Objective

We assessed the usefulness of contrast-enhanced ultrasound (CEUS) in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).

Methods

The CEUS enhancement patterns of 50 ICCs were retrospectively analysed and compared with 50 HCCs. Two readers independently reviewed the baseline ultrasound (BUS) and CEUS images and the diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis. Time–intensity curves (TIC) were plotted for quantification analysis.

Results

In the arterial phase, peripheral rim-like hyperenhancement, heterogeneous hyperenhancement, homogeneous hyperenhancement and heterogeneous hypoenhancement were found in 25, 10, 3 and 12 of the ICCs versus 2, 29, 19 and 0 of the HCCs (P < 0.001), respectively. The diagnostic performance of both readers in terms of the area under the ROC curve (0.745 vs. 0.933 for reader 1, and 0.803 vs. 0.911 for reader 2), sensitivity (28% vs. 90%, and 44% vs. 82%) and accuracy (64% vs. 90%, and 71% vs. 90%) improved significantly after CEUS (all P < 0.05). The interobserver agreement increased from κ = 0.575 at BUS to κ = 0.720 after CEUS. TICs demonstrated that the intensities of the peripheral and central portions of the ICCs were lower than those of HCCs (both P < 0.05).

Conclusion

CEUS improves the diagnostic performance significantly in the differentiation between ICC and HCC.

Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48(Suppl 1):S20–S37CrossRefPubMed

Sangiovanni A, Del Ninno E, Fasani P et al (2004) Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology 126:1005–1014CrossRefPubMed

Davila JA, El-Serag HB (2002) Cholangiocarcinoma: the “other” liver cancer on the rise. Am J Gastroenterol 97:3199–3200PubMed

Khan SA, Thomas HC, Davidson BR et al (2005) Cholangiocarcinoma. Lancet 366:1303–1314CrossRefPubMed

Khan SA, Davidson BR, Goldin R et al (2002) Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 51(Suppl 6):vi1–vi9CrossRefPubMed

Ng IO (1998) Prognostic significance of pathological and biological factors in hepatocellular carcinoma. J Gastroenterol Hepatol 13:666–670CrossRefPubMed

Wibulpolprasert B, Dhiensiri T (1992) Peripheral cholangiocarcinoma: sonographic evaluation. J Clin Ultrasound 20:303–314CrossRefPubMed

Colli A, Cocciolo M, Mumoli N et al (1998) Peripheral intrahepatic cholangiocarcinoma: ultrasound findings and differential diagnosis from hepatocellular carcinoma. Eur J Ultrasound 7:93–99CrossRefPubMed

Choi BI, Lee JM, Han JK (2004) Imaging of intrahepatic and hilar cholangiocarcinoma. Abdom Imaging 29:548–557PubMed

10.

Xu HX, Liu GJ, Lu MD et al (2006) Characterization of small focal liver lesions using real-time contrast-enhanced sonography: diagnostic performance analysis in 200 patients. J Ultrasound Med 25:349–361PubMed

11.

Xu HX, Lu MD, Liu GJ et al (2006) Imaging of peripheral cholangiocarcinoma with low-mechanical index contrast-enhanced sonography and SonoVue: initial experience. J Ultrasound Med 25:23–33PubMed

12.

Furuse J, Nagase M, Ishii H et al (2003) Contrast enhancement patterns of hepatic tumours during the vascular phase using coded harmonic imaging and Levovist to differentiate hepatocellular carcinoma from other focal lesions. Br J Radiol 76:385–392CrossRefPubMed

13.

Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update 2008. Ultraschall Med 29:28–44CrossRefPubMed

14.

Liu GJ, Xu HX, Lu MD et al (2007) Correlation between enhancement pattern of hepatocellular carcinoma on real-time contrast-enhanced ultrasound and tumour cellular differentiation on histopathology. Br J Radiol 80:321–330CrossRefPubMed

15.

Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236CrossRefPubMed

16.

Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430CrossRefPubMed

17.

Xu HX, Liu GJ, Lu MD et al (2006) Characterization of focal liver lesions using contrast-enhanced sonography with a low mechanical index mode and a sulfur hexafluoride-filled microbubble contrast agent. J Clin Ultrasound 34:261–272CrossRefPubMed

18.

Dietrich CF (2004) Characterisation of focal liver lesions with contrast enhanced ultrasonography. Eur J Radiol 51(Suppl):S9–S17CrossRefPubMed

19.

Nicolau C, Bru C (2004) Focal liver lesions: evaluation with contrast-enhanced ultrasonography. Abdom Imaging 29:348–359CrossRefPubMed

20.

von Herbay A, Vogt C, Willers R et al (2004) Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions. J Ultrasound Med 23:1557–1568

21.

Chen LD, Xu HX, Xie XY et al (2008) Enhancement patterns of intrahepatic cholangiocarcinoma: comparison between contrast-enhanced ultrasound and contrast-enhanced CT. Br J Radiol 81:881–889CrossRefPubMed

22.

Ros PR, Buck JL, Goodman ZD et al (1988) Intrahepatic cholangiocarcinoma: radiologic-pathologic correlation. Radiology 167:689–693PubMed

23.

Lim JH (2003) Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol 181:819–827PubMed

24.

Lim JH, Park CK (2004) Pathology of cholangiocarcinoma. Abdom Imaging 29:540–547PubMed

25.

Han JK, Choi BI, Kim AY et al (2002) Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings. Radiographics 22:173–187PubMed

26.

Ueda K, Terada T, Nakanuma Y et al (1992) Vascular supply in adenomatous hyperplasia of the liver and hepatocellular carcinoma: a morphometric study. Hum Pathol 23:619–626CrossRefPubMed

27.

Yoshida Y, Imai Y, Murakami T et al (1999) Intrahepatic cholangiocarcinoma with marked hypervascularity. Abdom Imaging 24:66–68CrossRefPubMed

28.

Valls C, Guma A, Puig I et al (2000) Intrahepatic peripheral cholangiocarcinoma: CT evaluation. Abdom Imaging 25:490–496CrossRefPubMed

29.

Klein D, Jenett M, Gassel HJ et al (2004) Quantitative dynamic contrast-enhanced sonography of hepatic tumors. Eur Radiol 14:1082–1091CrossRefPubMed

30.

Celik H, Ozdemir H, Yucel C et al (2005) Characterization of hyperechoic focal liver lesions: quantitative evaluation with pulse inversion harmonic imaging in the late phase of levovist. J Ultrasound Med 24:39–47PubMed

31.

Li J, Dong BW, Yu XL et al (2005) Time–intensity-based quantification of vascularity with single-level dynamic contrast-enhanced ultrasonography: a pilot animal study. J Ultrasound Med 24:975–983PubMed

32.

Hayashi M, Matsui O, Ueda K et al (2002) Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology 225:143–149CrossRefPubMed

33.

Kim TK, Jang HJ, Burns PN et al (2008) Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical-index contrast-enhanced sonography. AJR Am J Roentgenol 190:58–66CrossRefPubMed

Titel: Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound
verfasst von: Li-Da Chen
Hui-Xiong Xu
Xiao-Yan Xie
Xiao-Hua Xie
Zuo-Feng Xu
Guang-Jian Liu
Zhu Wang
Man-Xia Lin
Ming-De Lu
Publikationsdatum: 01.03.2010
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 3/2010
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-009-1599-8

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Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound