title: Dynamic contrast-enhanced ultrasound (DCE-US) for the characterization of hepatocellular carcinoma and cholangiocellular carcinoma.
abstract: OBJECTIVE
  In a prospective study, we compared the different perfusion kinetics of HCC and ICC using dynamic contrast-enhanced ultrasound (DCE-US).
  
  
  METHODS
  Patients with proven HCC and ICC were included. Three-minute video clips of CEUS examinations (CPS - low MI mode) after a bolus injection of 1.2 ml SonoVue were recorded and analyzed with quantification software (VueBox). Parameters for the arterial contrast enhancement [rise time (RT), time-to-peak (TTP)] towards portal venous contrast enhancement [mean transit time (local) (mTTl) and fall time (FT)] were quantified. Furthermore, contrast wash-out after peak enhancement (PE) (40 s, 80 s, 100 s and 120 s after PE) was compared between HCC and ICC.
  
  
  RESULTS
  43 patients with proven HCC (n = 23 HCC; cirrhosis n = 16) and ICC (n = 20 ICC; Cirrhosis n = 6) were examined. No statistical difference of the arterial DCEUS parameters was found between HCC and ICC. Contrast enhancement of the portal venous and late phases showed significantly lower values in the ICC group indicating early wash-out of the contrast agent: mTTl (p = 0.0209): HCC 118.4 s (SD± 88.4); ICC 64.8 s (SD± 49.7). FT (p = 0.0433): HCC 42.5 s (SD± 27.7); ICC 27.7 s (SD± 16.2). The percental loss of intensity at a definite time point after PE was significantly higher in ICC than in HCC lesions.
  
  
  CONCLUSIONS
  DCE-US is able to detect and quantify differences in perfusion kinetics between HCC and ICC. Whereas arterial contrast enhancement patterns may overlap between HCC and ICC, a timed characterization of wash-out kinetics may offer an additional tool to characterize HCC and ICC. The presence of a rapid loss of signal intensity in the early portal venous phase is significantly higher in ICC than in HCC lesions.
authors.affiliation: Internal medicine 1, University of Erlangen.
authors.forename: D
authors.initials: D
authors.lastname: Wildner
authors.affiliation: Internal medicine 1, University of Erlangen.
authors.forename: L
authors.initials: L
authors.lastname: Pfeifer
authors.affiliation: Internal medicine 1, University of Erlangen.
authors.forename: R S
authors.initials: RS
authors.lastname: Goertz
authors.affiliation: Department of Internal Medicine, District Hospital Ebersberg.
authors.forename: T
authors.initials: T
authors.lastname: Bernatik
authors.affiliation: Internal medicine 1, University of Erlangen.
authors.forename: J
authors.initials: J
authors.lastname: Sturm
authors.affiliation: Internal medicine 1, University of Erlangen.
authors.forename: M F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Internal medicine 1, University of Erlangen.
authors.forename: D
authors.initials: D
authors.lastname: Strobel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D018281:Cholangiocarcinoma / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010743:Phospholipids; D011446:Prospective Studies; D012984:Software; D013459:Sulfur Hexafluoride; D014463:Ultrasonography; D014741:Video Recording / Q000379:methods*
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride