Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Division of Gastroenterology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Abdom Radiol (NY). 2024 Jan;49(1):11-20. doi: 10.1007/s00261-023-04031-8. Epub 2023 Oct 7.
We have long noted unique portal venous phase (PVP) imaging discordance of focal liver masses between CEUS, showing rapid marked washout, and MRI, showing progressive or sustained enhancement. We postulate association of this unique discordance with intrahepatic cholangiocarcinoma (ICC) and causal relationship to different contrast agent behavior. We investigate this unique discordance, propose its clinical significance for ICC diagnosis, and confirm further histologic associations.
Cases were collected within our CEUS department and from pathology records over a ten-year interval. This retrospective review includes 99 patients, 73 with confirmed ICC and 26 other diagnoses, showing unique PVP discordance. The CEUS and MRI enhancement characteristics were compared for all patients.
Unique discordance is identified in 67/73 (92%) ICC and difference between the PVP appearance on MRI and CEUS is statistically significant (p < 0.0001). Arterial phase enhancement did not show statistically significant difference between CEUS and MRI, p > 0.05. Other diagnoses showing unique discordance include especially lymphoma (n = 7), sclerosed hemangioma (n = 6), HCC (n = 4), metastases (n = 2), and other rare entities.
ICC shows this discrepant intermodality enhancement pattern in a statistically significant number of cases and should be considered along with other LR-M features in at-risk patients. Discordance is also rarely seen in a number of other liver lesions.
我们长期以来注意到，CEUS 显示快速显著廓清，而 MRI 显示渐进性或持续性增强，两者之间局灶性肝脏肿块的门静脉期（PVP）成像存在独特的不匹配，我们推测这种独特的不匹配与肝内胆管细胞癌（ICC）有关，并与不同的对比剂行为存在因果关系。我们调查了这种独特的不匹配现象，提出了其对 ICC 诊断的临床意义，并进一步证实了组织学相关性。
本研究为回顾性研究，在十年的时间间隔内，我们在超声造影部门收集病例，并从病理记录中获取病例。本研究纳入了 99 例患者，其中 73 例经病理证实为 ICC，26 例为其他诊断，均表现出独特的 PVP 不匹配。比较了所有患者的 CEUS 和 MRI 增强特征。
在 73 例 ICC 中，有 67 例（92%）存在独特的不匹配，MRI 和 CEUS 上 PVP 表现之间存在统计学显著差异（p < 0.0001）。CEUS 和 MRI 的动脉期增强无统计学显著差异，p > 0.05。其他表现出独特不匹配的诊断包括淋巴瘤（n = 7）、硬化性血管瘤（n = 6）、HCC（n = 4）、转移瘤（n = 2）和其他罕见实体。
ICC 在具有统计学意义数量的病例中表现出这种不一致的模态增强模式，应结合其他 LR-M 特征在高危患者中进行考虑。这种不匹配在一些其他肝脏病变中也很少见。
