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PLOS ONE  2014 

Detailed Analysis of Temporal Features on Contrast Enhanced Ultrasound May Help Differentiate Intrahepatic Cholangiocarcinoma from Hepatocellular Carcinoma in Cirrhosis

DOI: 10.1371/journal.pone.0098612

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Abstract:

Aim To verify if detailed analysis of temporal enhancement patterns on contrast enhanced ultrasound (CEUS) may help differentiate intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in cirrhosis. Methods Thirty three ICC and fifty HCC in cirrhosis were enrolled in this study. The contrast kinetics of ICC and HCC was analyzed and compared. Results Statistical analysis did not reveal significant difference between ICC and HCC in the time of contrast first appearance and arterial peak maximum time. ICC displayed much earlier washout than that of HCC (47.93±26.45 seconds vs 90.86±31.26 seconds) in the portal phase, and most ICC (87.9%) showed washout before 60 seconds than HCC (16.0%). Much more ICC (78.8%) revealed marked washout than HCC (12.0%) while most HCC (88.0%) showed mild washout or no washout in late part of the portal phase (90–120 seconds). Twenty six out of thirty three ICC (78.8%) demonstrated both early washout(<60seconds) and marked washout in late part of the portal phase, whereas, only six of fifty HCC (12.0%)showed these temporal enhancement features (p = 0.000).When both early washout and marked washout in the portal phase are taken as diagnostic criterion for ICC, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78.8%,88.0%,81.3%,86.3%,and 84.3% respectively by CEUS. Conclusions Analysis of detailed temporal enhancement features on CEUS is helpful differentiate ICC from HCC in cirrhosis.If a nodule in cirrhotic liver displays hyper-enhancement in the arterial phase followed by early and marked washout in the portal phase, the nodule is highly suspicious of ICC rather than HCC.

References

[1]  Rimola J, Forner A, Tremosini S, Reig M, Vilana R, et al. (2012) Non-invasive diagnosis of hepatocellular carcinoma 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 56: 1317–1323. doi: 10.1016/j.jhep.2012.01.004
[2]  Serste T, Barrau V, Ozenne V, Vullierme MP, Bedossa P, et al. (2012) Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: role of biopsy. Hepatology 55: 800–806. doi: 10.1002/hep.24746
[3]  Shaib Y, El-Serag HB (2004) The epidemiology of cholangiocarcinoma. Semin Liver Dis 24: 115–125. doi: 10.1055/s-2004-828889
[4]  Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42: 1208–1236. doi: 10.1002/hep.20933
[5]  EASL-EORTC (2012) Clinical practice guidelines Management of hepatocellular carcinoma. J Hepatol 56: 908–943.
[6]  Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD (2005) Cholangiocarcinoma. Lancet 366: 1303–1314. doi: 10.1016/s0140-6736(05)67530-7
[7]  Blechacz B (2008) GoresGJ (2008) Cholangiocarcinoma: Advances in Pathogenesis, Diagnosis, and Treatment. Hepatology 48: 308–319. doi: 10.1002/hep.22310
[8]  Claudon M, Cosgrove D, Albrecht T, Bolondi L, Bosio M, et al. (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - update 2008. Ultraschall Med 29: 28–44. doi: 10.1055/s-2007-963785
[9]  Vilana R, Forner A, Bianchi L, Garcia-Criado A, Rimola J, et al. (2010) Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound. Hepatology 51: 2020–2029. doi: 10.1002/hep.23600
[10]  Li R, Zhang XH, Ma KS, Li XW, Xia F, et al. (2013) Dynamic enhancing vascular pattern of intrahepatic peripheral cholangiocarcinoma on contrast-enhanced ultrasound: the influence of chronic hepatitis and cirrhosis. Abdom Imaging 38: 112–119. doi: 10.1007/s00261-012-9854-x
[11]  GalassiM, Iavarone M, Rossi S, Bota S, Vavassori S, et al. (2013) Patterns of appearance and risk of misdiagnosis of intrahepatic cholangiocarcinoma in cirrhosis at contrast enhanced ultrasound. Liver International 33: 771–779. doi: 10.1111/liv.12124
[12]  Barreiros AP, Piscaglia F, Dietrich CF (2012) Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma(HCC): comments on AASLD guidelines. J Hepatol 57: 930–932. doi: 10.1016/j.jhep.2012.04.018
[13]  Rimola J, Forner A, Reig M, Vilana R, Rodríguez-Lope C, et al. (2009) Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology 50: 791–798. doi: 10.1002/hep.23071
[14]  Iavarone M, Piscaglia F, Vavassori S, Galassi M, Sangiovanni A, et al. (2013) Contrast enhanced CT-scan to diagnose intrahepatic cholangiocarcinoma in patients with cirrhosis. J Hepatol 58: 1188–1193. doi: 10.1016/j.jhep.2013.02.013
[15]  Strobel D, Seitz K, Blank W, Schuler A, Dietrich C, et al. (2008) Contrast-enhanced ultrasound for the characterization of focal liver lesions diagnostic accuracy in clinical practice (DEGUM multicentre trial). Ultraschall Med 29: 499–505. doi: 10.1055/s-2008-1027806
[16]  Tranquart F, Correas JM, Ladam Marcus V, Manzoni P, Vilqrain V, et al. (2009) Real time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study. J Radiol 90: 109–22.
[17]  Dietrich CF, Kratzer W, Strobe D, Danse E, Fessl R, et al. (2006) Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI. World J Gastroenterol 12: 1699–1705.
[18]  Sangiovanni A, Manini MA, Iavarone M, Romeo R, Forzenigo LV, et al. (2010) The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 59: 638–644. doi: 10.1136/gut.2009.187286
[19]  Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53: 1020–1022. doi: 10.1002/hep.24199
[20]  Chen LD, Xu HX, Xie XY, Xie XH, Xu ZF, et al. (2010) Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eue Radiol 20: 743–753. doi: 10.1007/s00330-009-1599-8
[21]  Bolondi L, Sofia S, Siringo S, Gaiani S, Casali A, et al. (2001) Surveillance program of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut 48: 251–259. doi: 10.1136/gut.48.2.251
[22]  Davila JA, Morgan RO, Richardson PA, Du XL, McGlynn KA, et al. (2010) Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology 52: 132–141. doi: 10.1002/hep.23615
[23]  Yang JD, Harmsen WS, Slettedahl SW, Chaiteerakij R, Enders FT, et al. (2011) Factors that affect risk for hepatocellular carcinomaand effects of surveillance. Clin Gastroenterology Hepatology 9: 617–623. doi: 10.1016/j.cgh.2011.03.027
[24]  Editorial (2011) Surveillance for hepatocellular carcinoma: a standard of care, not a clinical option. Hepatology 54: 1898–1900. doi: 10.1002/hep.24684
[25]  Boozari B, Soudah B, Rifai K, Schneidewind S, Vogel A, et al. (2011) Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography - a prospective study. Dig Liver Dis43: 484–90. doi: 10.1016/j.dld.2011.01.001
[26]  Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, et al. (2013) Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver-Update 2012. Ultraschall Med 34: 11–29. doi: 10.1055/s-0032-1325499
[27]  Bolondi L, Correas JM, Lencioni R, Weskott HP, Piscaglia F (2007) New perspectives for the use of contrast-enhanced liver ultrasound in clinical practice. Dig Liver Dis 39: 187–195. doi: 10.1016/j.dld.2006.08.008
[28]  Lencioni R, Piscaglia F, Bolondi L (2008) Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma. J Hepatol 48: 848–857. doi: 10.1016/j.jhep.2008.02.005

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