, Volume 113, Issue 1, pp 76-86
Date: 25 Feb 2008

Intrahepatic peripheral cholangiocarcinoma (IPCC): comparison between perfusion ultrasound and CT imaging

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Abstract

Purpose

This study was done to compare the perfusion patterns of intrahepatic peripheral cholangiocarcinoma (IPCC) on contrast-enhanced ultrasound (CEUS) and dynamic computed tomography (CT).

Materials and methods

We retrospectively reviewed 23 histologically proven cases of IPCC. All lesions were studied by CEUS with sulfur hexafluoride-filled microbubbles coated with a phospholipid capsule, and by dynamic CT. Contrast-enhancement patterns were evaluated in the arterial phase (CEUS 10–20 s after the injection; CT 25–30 s after the injection) and in the delayed phase (CEUS 120 s after the injection; CT>2–3 min after the injection).

Results

Lesions were single in 18/23 cases (78%), single with nearby satellite lesions in 1/23 (4%) cases and multifocal with distant secondary lesions in 4/23 (17%) cases. Lesion diameter was 2–5 cm in 7/23 cases (30%), 5–7 cm in 13/23 cases (57%) and >7 cm in 3/23 (13%) cases. On CEUS, lesions were hypervascular in 16/23 cases (70%). On delayed-phase CEUS, 22/23 lesions (96%) were markedly hypoechoic. CT showed that the lesions were hypovascular in the arterial phase in 15/23 cases (66%) and hypervascular in 7/23 (30%) cases; one lesion (1/23; 4%) was isovascular. On delayed-phase CT, lesions were hyperdense in 17/23 cases (74%), hypodense in 5/23 (22%) cases and isodense in 1/23 (43%) cases.

Conclusions

Enhancement discrepancy between delayed-phase CEUS (hypoechogenicity) and CT (hyperdensity) is common semiological findings in the study of IPCC.

Riassunto

Obiettivo

Confrontare le caratteristiche perfusionali del colangiocarcinoma intra-epatico periferico (IPCC) in ecografia con mdc (CEUS) e TC dinamica.

Materiali e metodi

Analisi retrospettiva di 23 casi di colangiocarcinoma periferico istologicamente accertati. Tutte le lesioni sono state studiate con CEUS utilizzando microbolle a base di esaflururo di zolfo ricoperte da una capsula di fosfolipidi quale mezzo di contrasto e con TC dinamica. Sono state valutate le caratteristiche della impregnazione lesionale nelle fasi arteriosa (CEUS: 10–20 s dopo l’iniezione; TC: 25–30 s dopo l’iniezione) e tardiva (CEUS: 120 s dopo l’iniezione; TC>2–3 min dopo l’iniezione).

Risultati

In 18/23 (78%) la lesione era singola, in 1/23 (4%) singola con lesioni satelliti a ridosso della lesione principale e in 4/23 (17%) multifocale con lesioni a distanza rispetto alla lesione prinicipale. Le dimensioni delle lesioni erano comprese tra 2 e 5 cm di diametro in 7/23 (30%), tra 5 e 7 cm in 13/23 (57%) e superiori a 7 cm in 3/23 (13%). La CEUS ha evidenziato ipervascolarizzazione delle lesioni in 16/23 (70%). Ventidue su 23 lesioni (96%) in fase tardiva CEUS, sono risultate marcatamente ipoecogene. La TC ha evidenziato ipovascolarizzazione delle lesioni in fase arteriosa in 15/23 (66%) ed ipervascolarizzazione in 7/23 (30%); una lesione (1/23; 4%) era isovascolarizzata. In fase tardiva TC la lesione era iperdensa in 17/23 (74%) casi, ipodensa in 5/23 (22%) e isodensa in 1/23 (43%) casi.

Conclusioni

Il riscontro di una discordanza di enhancement in fase tardiva tra CEUS (ipoecogenicità) e TC (iperdensità) rappresenta frequente rilievo semeiologico nello studio del colangiocarcinoma intraepatico periferico.