Department of Ultrasound, Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Ultrasound Med Biol. 2023 Aug;49(8):1780-1788. doi: 10.1016/j.ultrasmedbio.2023.03.026. Epub 2023 May 6.
The aim of the work described here was to investigate the value of dynamic contrast enhanced ultrasound (DCE-US) and quantitative analysis in pre-operative differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) in non-cirrhotic liver.
In this retrospective study, patients with histopathologically proven ICC and HCC lesions in non-cirrhotic liver were included. All patients underwent contrast-enhanced ultrasound (CEUS) examinations with an Acuson Sequoia unit (Siemens Healthineers, Mountain View, CA, USA) unit or LOGIQ E20 (GE Healthcare, Milwaukee, WI, USA) within 1 wk before surgery. SonoVue (Bracco, Milan, Italy) was used as the contrast agent. B-mode ultrasound (BMUS) features and CEUS enhancement patterns were analyzed. DCE-US analysis was performed by VueBox software (Bracco). Two regions of interest (ROIs) were set in the center of the focal liver lesions and their surrounding liver parenchyma. Time-intensity curves (TICs) were generated, and quantitative perfusion parameters were obtained and compared between the ICC and HCC groups using the Student t-test or Mann-Whitney U-test.
From November 2020 to February 2022, patients with histopathologically confirmed ICC (n = 30) and HCC (n = 24) lesions in non-cirrhotic liver were included. During the arterial phase (AP) of CEUS, ICC lesions exhibited heterogeneous hyperenhancement (13/30, 43.3%), heterogeneous hypo-enhancement (2/30, 6.7 %) and rim-like hyperenhancement (15/30, 50.0%), whereas all HCC lesions exhibited heterogeneous hyperenhancement (24/24, 100.0%) (p < 0.05). Subsequently, most of the ICC lesions exhibited AP wash-out (83.3%, 25/30), whereas a few cases exhibited wash-out in the portal venous phase (PVP) (15.7%, 5/30). In contrast, HCC lesions exhibited AP wash-out (41.7%, 10/24), PVP wash-out (41.7%, 10/24) and a small part of late phase wash-out (16.7%, 4/24) (p < 0.05). Compared with those of HCC lesions, TICs of ICCs revealed earlier and lower enhancement during the AP, faster decline during the PVP and reduced area under the curve. The combined area under the receiver operating characteristic curve (AUROC) of all significant parameters was 0.946, with 86.7% sensitivity, 95.8% specificity and 90.7% accuracy in differential diagnosis between ICC and HCC lesions in non-cirrhotic liver, which improved the diagnostic efficacy of CEUS (58.3% sensitivity, 90.0% specificity and 75.9% accuracy).
ICC and HCC lesions in non-cirrhotic liver might exhibit some overlap of CEUS features in diagnosis. DCE-US with quantitative analysis would be helpful in pre-operative differential diagnosis.
本研究旨在探讨动态对比增强超声（DCE-US）及定量分析在非肝硬化肝脏内肝内胆管细胞癌（ICC）和肝细胞癌（HCC）术前鉴别诊断中的价值。
本回顾性研究纳入了经组织病理学证实的非肝硬化肝脏内 ICC 和 HCC 病变患者。所有患者均在术前 1 周内行超声造影（CEUS）检查，采用 Acuson Sequoia （西门子医疗，Mountain View，CA，USA）或 LOGIQ E20 （通用电气医疗，Milwaukee，WI，USA）。造影剂使用 SonoVue（博莱科，米兰，意大利）。分析 B 型超声（BMUS）特征和 CEUS 增强模式。DCE-US 分析采用 VueBox 软件（博莱科）。在病灶中心和周围肝实质分别设置 2 个感兴趣区（ROI）。生成时间-强度曲线（TIC），采用 Student t 检验或 Mann-Whitney U 检验比较 ICC 组和 HCC 组的定量灌注参数。
2020 年 11 月至 2022 年 2 月，共纳入 30 例经组织病理学证实的 ICC 病灶和 24 例 HCC 病灶患者。CEUS 动脉期（AP），ICC 病灶呈不均匀高增强（13/30，43.3%）、不均匀低增强（2/30，6.7%）和边缘高增强（15/30，50.0%），而所有 HCC 病灶均呈不均匀高增强（24/24，100.0%）（p<0.05）。随后，大多数 ICC 病灶呈 AP 廓清（83.3%，25/30），少数病例呈门静脉期廓清（15.7%，5/30）。相反，HCC 病灶呈 AP 廓清（41.7%，10/24）、门静脉期廓清（41.7%，10/24）和部分延迟期廓清（16.7%，4/24）（p<0.05）。与 HCC 病灶相比，ICC 病灶的 TIC 在 AP 期表现为更早、更低的增强，门静脉期下降更快，曲线下面积减小。所有有统计学意义参数的联合受试者工作特征曲线（AUROC）为 0.946，在非肝硬化肝脏 ICC 和 HCC 病变的鉴别诊断中具有 86.7%的敏感性、95.8%的特异性和 90.7%的准确性，提高了 CEUS 的诊断效能（敏感性 58.3%，特异性 90.0%，准确性 75.9%）。
非肝硬化肝脏 ICC 和 HCC 病灶在 CEUS 特征上可能存在一定的重叠。DCE-US 联合定量分析有助于术前鉴别诊断。
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