Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions

Abstract

ObjectiveTo investigate differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and arterial phase enhanced hepatic inflammatory lesions in patients without liver cirrhosis using contrast-enhanced ultrasound (CEUS).MethodsICC and hepatic inflammatory lesions cases with CEUS and pathological diagnosis between Sep 2013 and Oct 2016 were investigated retrospectively. Imaging features of conventional ultrasound and CEUS were analyzed. The parameters of time intensity curve (TIC), including the arrival time, peak intensity (PI) in the lesions, the starting time for washout, and the intensity difference at 3 min (ΔI3) after contrast agent infection between the lesion and the liver parenchyma, were compared between ICC and hepatic inflammatory lesions. ResultsTwenty-five ICC and fifteen inflammatory patients were included in this study. Seventeen ICC (68.0%) and two inflammatory cases (13.3%) showed bile duct dilatation on conventional ultrasound. Using CEUS, three ICC cases (12.0%) were misdiagnosed as inflammatory lesions and three inflammatory lesions (20.0%) as ICC; two ICC (8.0%) and one inflammatory case (6.7%) could not be made definite diagnosis. Washout started at 34.5±3.5 s and 61.5±12.9 s for ICC and inflammatory lesions respectively (P<0.001). The intensity difference between lesion and liver parenchyma at 3 min after contrast agent injection was 10.8±3.1 dB in ICC and 4.2±2.3 dB in inflammatory group (P<0.001). The sensitivity and specificity differentiating ICC and inflammatory lesions were 76% and 87% if the cut-off value of the intensity difference was 7.7 dB.ConclusionsCombined with TIC analysis, and particularly with the characteristic of the early-starting and obvious washout in ICC, CEUS can be useful in differential diagnosis between hepatic inflammatory lesions and ICC.

Ultrasound and contrast-enhanced ultrasound (CEUS) in infective liver lesions

“…It has been found that the washout starts significantly early in malignancy as compared to infections. Similarly, a cut-off of 7.7 dB for intensity difference at 3 minutes into a CEUS study has been shown to have good sensitivity and specificity (76 % and 87 %, respectively) in differentiating the 2 types of lesions [25].…”

Cholangiocarcinoma Evaluation via Imaging and Artificial Intelligence

“…Contrast-enhanced US has been reported to be used in preoperative evaluation of CCA – for example, the vascular pattern of the tumor, differential diagnosis with hepatic inflammatory lesions, and correlation with clinicopathologic findings and prognosis – indicating great potential for the evaluation of both luminal and extraluminal masses in CCA diagnosis [13, 31, 32].…”

“…To date, multiple imaging techniques have been utilized for preoperative evaluation of CCA, including ultrasonography (US) [11-13], computerized tomography (CT) [14-16], positron emission tomography (PET) [17, 18], magnetic resonance imaging (MRI) [19-21], and cholangioscopy [22, 23]. Meanwhile, artificial intelligence (AI) techniques have influenced changes across healthcare and have been used in many biomedical areas, especially oncology [24].…”

Contrast‐enhanced ultrasound combined with augmented reality medical technology in the treatment of rabbit liver cancer with high‐energy focused knife

“…Although his research method is relatively novel, but its limitations are more obvious. 5 Li C evaluated 117 patients with 120 BI-RADS 4a-5 breast lesions by routine US, CEUS, and MRI. 6 SonoVue was used as contrast agent in CEUS and injected intravenously.…”