Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Hemorheol Microcirc. 2021;79(2):293-309. doi: 10.3233/CH-211145.
To explore the diagnostic ability of contrast-enhanced ultrasound (CEUS) in distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC).
PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for studies reporting the diagnostic accuracy of CEUS in differentiating ICC from HCC. The diagnostic ability of CEUS was assessed based on the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) with 95% confidence intervals (CIs). The methodologic quality was assessed by the QUADAS-2 tool. Subgroup analyses, meta-regression and investigation of publication bias were performed to identify the source of heterogeneity.
A total of eight studies were included, consisting of 1,116 patients with HCC and 529 with ICC. The general diagnostic performance of CEUS in distinguishing ICC and HCC were as follows: pooled sensitivity, 0.92 (95% CI: 0.84-0.96); pooled specificity, 0.87 (95% CI: 0.79-0.92); pooled PLR, 7.1 (95% CI: 4.1-12.0); pooled NLR, 0.09 (95% CI: 0.05-0.19); pooled DOR, 76 (95% CI: 26-220) and AUC, 0.95 (95% CI: 0.93-0.97). Different liver background may be a potential factor that influenced the diagnostic accuracy of CEUS according to the subgroup analysis, with the pooled DOR of 89.67 in the mixed liver background group and 46.87 in the cirrhosis group, respectively. Six informative CEUS features that may help differentiate HCC from ICC were extracted. The three CEUS features favoring HCC were arterial phase hyperenhancement (APHE), mild washout and late washout (>60s); the three CEUS favoring ICC were arterial rim enhancement, marked washout and early washout (<60s). No potential publication bias was observed.
CEUS showed great diagnostic ability in differentiating ICC from HCC, which may be promising for noninvasive evaluation of these diseases.
探讨超声造影（CEUS）在鉴别肝内胆管细胞癌（ICC）和肝细胞癌（HCC）中的诊断能力。
系统检索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 中关于 CEUS 鉴别 ICC 和 HCC 的诊断准确性的研究。根据汇总敏感性、特异性、诊断比值比（DOR）、阳性似然比（PLR）、阴性似然比（NLR）和曲线下面积（AUC）及其 95%置信区间（CI）评估 CEUS 的诊断能力。采用 QUADAS-2 工具评估方法学质量。进行亚组分析、meta 回归和发表偏倚分析，以确定异质性的来源。
共纳入 8 项研究，包括 1116 例 HCC 患者和 529 例 ICC 患者。CEUS 鉴别 ICC 和 HCC 的总体诊断性能如下：汇总敏感性为 0.92（95%CI：0.84-0.96）；汇总特异性为 0.87（95%CI：0.79-0.92）；汇总 PLR 为 7.1（95%CI：4.1-12.0）；汇总 NLR 为 0.09（95%CI：0.05-0.19）；汇总 DOR 为 76（95%CI：26-220）；AUC 为 0.95（95%CI：0.93-0.97）。根据亚组分析，不同的肝脏背景可能是影响 CEUS 诊断准确性的一个潜在因素，混合肝脏背景组的汇总 DOR 为 89.67，肝硬化组为 46.87。提取了 6 个可能有助于鉴别 HCC 和 ICC 的有意义的 CEUS 特征。支持 HCC 的三个 CEUS 特征为动脉期增强（APHE）、轻度廓清和晚期廓清（＞60s）；支持 ICC 的三个 CEUS 特征为动脉边缘增强、明显廓清和早期廓清（＜60s）。未发现潜在的发表偏倚。
CEUS 在鉴别 ICC 和 HCC 方面具有很好的诊断能力，有望成为这些疾病的非侵入性评估方法。
