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.
Eur Radiol. 2010 Mar;20(3):743-53. doi: 10.1007/s00330-009-1599-8. Epub 2009 Sep 4.
We assessed the usefulness of contrast-enhanced ultrasound (CEUS) in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).
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.
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 kappa = 0.575 at BUS to kappa = 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).
CEUS improves the diagnostic performance significantly in the differentiation between ICC and HCC.
我们评估了超声造影（CEUS）在鉴别肝内胆管细胞癌（ICC）和肝细胞癌（HCC）中的作用。
回顾性分析了 50 例 ICC 的 CEUS 增强模式，并与 50 例 HCC 进行比较。两位读者分别独立地对基础超声（BUS）和 CEUS 图像进行了复查，并通过接受者操作特征（ROC）分析评估了诊断性能。绘制时间-强度曲线（TIC）进行定量分析。
在动脉期，25 例 ICC 中观察到外周边缘状高增强、异质性高增强、均质性高增强和异质性低增强，而 50 例 HCC 中分别为 2 例、29 例、19 例和 0 例（P<0.001）。两位读者在 ROC 曲线下面积（0.745 与 0.933，对于读者 1；0.803 与 0.911，对于读者 2）、敏感度（28%与 90%，44%与 82%）和准确性（64%与 90%，71%与 90%）方面的诊断性能在 CEUS 后均显著提高（均 P<0.05）。观察者间的一致性从 BUS 时的κ=0.575 增加到 CEUS 后的κ=0.720。TIC 显示，ICC 的外周和中央部分的强度均低于 HCC（均 P<0.05）。
CEUS 显著提高了 ICC 和 HCC 之间的鉴别诊断性能。
