Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Eur J Radiol. 2022 Sep;154:110415. doi: 10.1016/j.ejrad.2022.110415. Epub 2022 Jun 18.
To analyze the contrast-enhanced ultrasound (CEUS) manifestations of combined hepatocellular-cholangiocarcinoma (CHC) and to investigate the diagnostic value of the 2017 version of the CEUS Liver Imaging Reporting and Data System (LI-RADS) and serum tumor markers in CHC.
A total of 66 pathologically confirmed CHC nodules were retrospectively analyzed. We summarized the CEUS manifestations of CHC and analyzed the relationship between serum tumor markers and the enhancement pattern of CHC. We also classified CHC according to CEUS LI-RADS criteria. The Kappa test was used to assess the interreader agreement of CEUS LI-RADS between radiologists.
According to the results, 52 of 62 (83.9%) patients had elevated alpha-fetoprotein (AFP), 19 of 61 (31.1%) had elevated carbohydrate antigen 199 (CA 199), and 13 of 61 (21.3%) had both elevated AFP and CA 199. Of the 66 CHC nodules, 64 (97.0%) were identified as malignant lesions by CEUS, 13 (19.7%) showed a hepatocellular carcinoma-like enhancement pattern, and 21 (31.8%) showed a cholangiocarcinoma-like enhancement pattern. For the CEUS LI-RADS categories, 39 of 53 (73.6%) CHC nodules were classified as LR-M, 12 (22.6%) were classified as LR-5, and 2 (3.8%) were classified as LR-4. The interreader agreement for the LI-RADS categories was 0.60.
Although CHC lacks specific CEUS features, CEUS LI-RADS and serum tumor markers can be useful tools for reducing the misdiagnosis of CHC. In addition, due to the relative complexity of the CEUS features involved in CHC, it is necessary for beginning radiologists to learn more about CEUS features.
分析肝细胞癌-胆管细胞癌（CHC）的超声造影（CEUS）表现，探讨 2017 版 CEUS 肝脏影像报告和数据系统（LI-RADS）及血清肿瘤标志物在 CHC 诊断中的价值。
回顾性分析 66 例经病理证实的 CHC 结节，总结 CHC 的 CEUS 表现，并分析血清肿瘤标志物与 CHC 增强模式的关系，按照 CEUS LI-RADS 标准对 CHC 进行分类，采用 Kappa 检验评估两位放射科医师间 CEUS LI-RADS 的一致性。
62 例 AFP 升高患者中，52 例（83.9%）升高，61 例 CA199 升高患者中，19 例（31.1%）升高，61 例患者中，13 例（21.3%）同时升高 AFP 和 CA199。66 例 CHC 结节中，CEUS 诊断 64 例（97.0%）为恶性病变，13 例（19.7%）呈肝细胞癌样增强模式，21 例（31.8%）呈胆管细胞癌样增强模式。CEUS LI-RADS 分类中，39 例（73.6%）CHC 结节为 LR-M，12 例（22.6%）为 LR-5，2 例（3.8%）为 LR-4。LI-RADS 分类的两位观察者间一致性为 0.60。
尽管 CHC 缺乏特异性的 CEUS 特征，但 CEUS LI-RADS 和血清肿瘤标志物有助于减少 CHC 的误诊。此外，由于 CHC 涉及的 CEUS 特征相对复杂，对于初学者放射科医师来说，有必要进一步了解 CEUS 特征。
