title: Detailed analysis of temporal features on contrast enhanced ultrasound may help differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma in cirrhosis.
abstract: OBJECTIVE
  To verify if detailed analysis of temporal enhancement patterns on contrast enhanced ultrasound (CEUS) may help differentiate intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in cirrhosis.
  
  
  METHODS
  Thirty three ICC and fifty HCC in cirrhosis were enrolled in this study. The contrast kinetics of ICC and HCC was analyzed and compared.
  
  
  RESULTS
  Statistical analysis did not reveal significant difference between ICC and HCC in the time of contrast first appearance and arterial peak maximum time. ICC displayed much earlier washout than that of HCC (47.93±26.45 seconds vs 90.86±31.26 seconds) in the portal phase, and most ICC (87.9%) showed washout before 60 seconds than HCC (16.0%). Much more ICC (78.8%) revealed marked washout than HCC (12.0%) while most HCC (88.0%) showed mild washout or no washout in late part of the portal phase (90-120 seconds). Twenty six out of thirty three ICC (78.8%) demonstrated both early washout(<60 seconds) and marked washout in late part of the portal phase, whereas, only six of fifty HCC (12.0%)showed these temporal enhancement features (p = 0.000).When both early washout and marked washout in the portal phase are taken as diagnostic criterion for ICC, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78.8%,88.0%,81.3%,86.3%,and 84.3% respectively by CEUS.
  
  
  CONCLUSIONS
  Analysis of detailed temporal enhancement features on CEUS is helpful differentiate ICC from HCC in cirrhosis.If a nodule in cirrhotic liver displays hyper-enhancement in the arterial phase followed by early and marked washout in the portal phase, the nodule is highly suspicious of ICC rather than HCC.
authors.affiliation: Department of Ultrasound, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Meng-Xia
authors.initials: MX
authors.lastname: Yuan
authors.affiliation: Department of Hepato-biliary-Pancreatic Surgery, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Kuan-sheng
authors.initials: KS
authors.lastname: Ma
authors.affiliation: Department of Hepato-biliary-Pancreatic Surgery, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Xiao-Wu
authors.initials: XW
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Tang
authors.affiliation: Department of Ultrasound, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Xiao-Hang
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: De-Yu
authors.initials: DY
authors.lastname: Guo
authors.affiliation: Department of Pathology, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.
authors.forename: Xiao-Chu
authors.initials: XC
authors.lastname: Yan
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D018281:Cholangiocarcinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media