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

  • Ultrasound
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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.

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Acknowledgments

This work was supported in part by grant NCET-06-0723 from Chinese Ministry of Education and grant 2008-2-10 from the Public Welfare Research Special Project of the Chinese Ministry of Science and Technology.

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Authors and Affiliations

  1. Department of Medical Ultrasonics, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China

    Li-Da Chen, Hui-Xiong Xu, Xiao-Yan Xie, Xiao-Hua Xie, Zuo-Feng Xu, Guang-Jian Liu, Zhu Wang & Man-Xia Lin

  2. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China

    Ming-De Lu

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  1. Li-Da Chen
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  2. Hui-Xiong Xu
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Correspondence to Hui-Xiong Xu or Ming-De Lu.

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Chen, LD., Xu, HX., Xie, XY. et al. Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol 20, 743–753 (2010). https://doi.org/10.1007/s00330-009-1599-8

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  • DOI: https://doi.org/10.1007/s00330-009-1599-8

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