title: CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients - early or late washout matters: a subanalysis of the DEGUM multicenter trial.
abstract: OBJECTIVE
  The aim of the study was the comparison of tumor vascularization and contrast enhancement in contrast-enhanced ultrasound (CEUS) for the characterization of hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (ICC). We present data of the subpopulations HCC and ICC examined in the DEGUM multicenter trial for the characterization of focal liver lesions in clinical practice.
  
  
  METHODS
  Based on the data of the DEGUM multicenter trial (1349 patients), all patients with histologically proven HCC (n = 278) and ICC (n = 42) were analyzed. The vascularity pattern and contrast enhancement pattern during the arterial, portal-venous and late phase were compared.
  
  
  RESULTS
  An underlying liver cirrhosis was found in 214/278 patients with HCC (76.9 %) and 7/42 patients with ICC (16.7 %). In CEUS, HCC showed a global arterial hyperenhancement compared to ICC (HCC: tumor center: 60.3 %; tumor periphery: 75 %; ICC: tumor center: 16.7 %; tumor periphery: 40.5 %). ICC showed an initial contrast enhancement primarily at the tumor periphery (ICC: 85.7 % vs. HCC: 61 %) followed by an early portal-venous contrast washout in the tumor center (ICC: 85.8 % vs. HCC: 49.8 %) and tumor periphery (ICC: 66.7 % vs. HCC: 32.6 %). HCC showed a delayed contrast washout (late phase hypoenhancement: HCC: 75 % vs. ICC: 92.9 %).
  
  
  CONCLUSIONS
  ICCs are rare in cirrhotic livers. CEUS can demonstrate differences in the vascularization patterns between HCC and ICC. HCC showed an arterial global hyperenhancement and delayed contrast washout in the late phase. ICCs are characterized by an arterial contrast enhancement at the tumor periphery with early contrast washout of the vascularized parts of the lesions in the portal-venous and late phase.
authors: Department of Internal Medicine 1, University Hospital Erlangen, Germany.
authors: D
authors: D
authors: Wildner
authors: Department of Internal Medicine, District Hospital Ebersberg, Germany.
authors: T
authors: T
authors: Bernatik
authors: Department of Clinical Research, Bracco Imaging Deutschland, Konstanz, Germany.
authors: C
authors: C
authors: Greis
authors: Department of Medicine, District Hospital Sigmaringen, Germany.
authors: K
authors: K
authors: Seitz
authors: Department of Internal Medicine 1, University Hospital Erlangen, Germany.
authors: M F
authors: MF
authors: Neurath
authors: Department of Internal Medicine 1, University Hospital Erlangen, Germany.
authors: D
authors: D
authors: Strobel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000098:blood supply* / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media