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

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.

Multimodality imaging of intrahepatic cholangiocarcinoma

“…A third agent is taken up by Kupffer cells in the liver and exhibits a hepatobiliary phase 1 hour after injection, with a utility similar to that of the hepatobiliary agents utilized in MRI (11). This may be useful for distinguishing intrahepatic forms of cholangiocarcinoma from hepatocellular carcinoma (12).…”

Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients

“…This was observed by Liu et al [15] in 92.3% of HCC and in 85.7% of CC found in 819 patients. However, CC lesions had an earlier washout than HCC lesions (media of 27.5 vs. 70.1 s).…”

Recent Trends in the Management of Hepatocellular Carcinoma with Special Emphasis on Treatment with Regorafenib and Immune Checkpoint Inhibitors

“…The first is that contrast-enhanced US (CEUS) [1,2] is sensitive in detecting hypervascularity in nodules that cannot be identified by gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI) or dynamic multidetector CT (MDCT) [3], as CEUS allows for real-time visualization and does not overlook the influx of arterial blood into these nodules. Thus, nodules diagnosed as ‘hypovascular' by EOB-MRI or dynamic MDCT should be evaluated by CEUS to assess the degree of intranodular arterial vascularity.…”