Diagnostic value of color parametric imaging and contrast‐enhanced ultrasound in the differentiation of hepatocellular adenoma and well‐differentiated hepatocellular carcinoma

Abstract

Purpose: To investigate the differential diagnostic value of computer-aided color parametric imaging (CPI) and contrast-enhanced ultrasound (CEUS) in hepatocellular adenoma (HCA) and well-differentiated hepatocellular carcinoma (wHCC).Method: A total of 38 patients who underwent CEUS and were pathologically diagnosed with HCA (10 cases) and wHCC (28 cases) were reviewed retrospectively. The differences between the radiological features of HCA and wHCC were compared by two readers, blinded to the final diagnosis.Results: (a) Sonographic features: on gray-scale ultrasound, halo sign was more common in wHCC than in HCA (60.7% vs. 10.0%, p = 0.009). On CEUS, hyper-or isoenhancement was more common in HCA in the portal phase (90.0% vs. 50.0%; p = 0.022). On CPI mode, HCA was inclined toward centripetal enhancement (60.0% vs. 14.3% p = 0.010). HCA was characterized by the presence of pseudocapsule enhancement (50.0% vs. 14.3%; p = 0.036). Quantitative analysis showed that the arrival time of HCA was earlier than that of wHCC (12.4 ± 3.7 s vs. 15.9 ± 3.2 s; p = 0.006). (b) Interobserver agreement was improved by using CPI compared with CEUS. The diagnostic sensitivity, specificity, and accuracy of the combination were 80.0%, 85.7%, and 84.2%, respectively.Conclusions: CEUS combined with CPI can provide effective information for the differential diagnosis of HCA and wHCC, especially for the non-experienced radiologists.

The added value of color parameter imaging for the evaluation of focal liver lesions with “homogenous hyperenhancement and no wash out” on contrast enhanced ultrasound

“…The characteristics of FLLs on CPI were related to the pathological features of the lesions. Several studies have found that there is a “mosaic” in HCC ( 6 , 7 ). This phenomenon occurred due to the increased tumor vascularity.…”

“…In our study, the better temporal resolution of CPI allowed us to visualize more peripheral nodular enhancement on CPI. The diagnosis and differential diagnosis of hepatic adenoma and HCC were analyzed in several previous studies ( 7 , 14 , 34 , 35 ). Some studies have proposed that “pseudocapsular” or “subcapsular vessel” are commonly seen in hepatic adenomas ( 7 , 14 ).…”

“…The diagnosis and differential diagnosis of hepatic adenoma and HCC were analyzed in several previous studies ( 7 , 14 , 34 , 35 ). Some studies have proposed that “pseudocapsular” or “subcapsular vessel” are commonly seen in hepatic adenomas ( 7 , 14 ). In our study, “subcapsular vessel” was a specific manifestation of adenomas on CPI (senior: 6/6, 100%; junior: 5/6, 83.3%) and the “subcapsular vessel” was only present in hepatic adenomas.…”

“…According to the previous reports and our analysis, the characteristics of CPI were summarized as follows: (a) centripetal perfusion: enhanced from the periphery to the center; (b) eccentric perfusion: enhanced from one side to another side; (c) centrifugal perfusion: enhancement started from the center to the periphery; (d) peripheral nodular enhancement: round or semicircle-shaped enhancement visualized at the peripheral area of lesions; (e) feeding artery: hypertrophic vessel directed toward the tumor that was substantially larger than other vascular branches at the same depth (2 mm–3 mm in diameter); (f) subcapsular vessel: thick and tortuous blood vessel under the tumor capsule; (g) spoke-wheel vessels: arteries with a spoke-wheel or starlike morphology in the center of the lesion during the arterial phase; (h) mosaic enhancement: one or more hypertrophic tortuous arteries that reached the edge of the lesion, partially encircling the nodule and penetrating internally with a basket or chaotic distribution; (i) branched vessels: hypertrophic tortuous vessels with a few branches or dendritic vessels; and (j) blue and pink ingredients>2/3 or red ingredients >1/3 ( Figure 2 ) ( 6 , 7 , 10 , 11 , 14 ).…”

Contrast-Enhanced Imaging Features and Clinicopathological Investigation of Steatohepatitic Hepatocellular Carcinoma

“…In contrast, HCAs may exhibit hypo-enhancement in the late phases for lack of portal vein branches [ 35 ]. The washout of HCCs in non-cirrhotic liver is also supposed to be concerned with their differentiation grade: the moderate differentiated nodules (grade II/III) exhibit mild washout during the late phase, whereas the well-differentiated lesions (grade II/III) are continuously hyperenhanced during the late phase [ 15 , 36 ]. However, the SH-HCCs in the present study were all moderately differentiated (46.2% of grade II, 53.8% of grade III, respectively).…”