Advertisement

Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and without risks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017

  • Fei Li
  • Qing Li
  • Yubo Liu
  • Jing Han
  • Wei Zheng
  • Yini Huang
  • Xueyi Zheng
  • Longhui CaoEmail author
  • Jian-hua ZhouEmail author
Ultrasound

Abstract

Purpose

To assess the diagnostic performance of the LR-M criteria of Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 in differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in patients with and without risk factors for HCC.

Methods

Fifty-four ICC in patients with risks and 55 ICC in patients without risks and matched control cases of HCC with and without risks (n = 59 and n = 55, respectively) were enrolled. The enhanced features of the lesions were retrospectively analyzed according to LR-M criteria. The diagnostic performances including the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of LR-M criteria were assessed.

Result

Peripheral rim-like hyperenhancement, early washout (< 45 or 60s), and marked washout did not differ between ICCs with and without risks, while all of these features were more common in ICCs than in HCCs (p < 0.05) no matter if patients were with and without risk factors. Using the LR-M criteria to differentiate ICC from HCC, the AUC, sensitivity, specificity, and accuracy were 0.92, 97.25%, 87.72%, and 92.38%, respectively. If early washout onset was adjusted to < 45 s, the specificity was significantly increased to 95.61% (p = 0.004) without losing sensitivity (96.33%, p = 0.945). The rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.

Conclusion

Although the LR-M criteria showed high sensitivity in distinguishing ICCs from HCCs in patients with and without risks, the specificity would be significantly increased after adjustments to current criteria.

Key Points

• The LR-M criteria of CEUS-LI-RADS v2017 could be used for distinguishing ICC from HCC not only in patients with risk factors for HCC but also in those without risk factors.

• The diagnostic performance of differentiating ICC from HCC by using the LR-M criteria showed high AUC (0.92), high sensitivity (97.25%), intermediate specificity (87.72%), and high accuracy (92.38%).

• If the onset of early washout was adjusted to < 45 s, the specificity was significantly increased from 87.72 to 95.61% (p = 0.004) without losing sensitivity (p = 0.945), and the rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.

Keywords

Hepatocellular carcinoma Intrahepatic cholangiocarcinoma Contrast media Ultrasonography 

Abbreviations

AASLD

American Association for the Study of Liver Diseases

ACR

American College of Radiology

AUC

Area under the ROC curve

BUS

B-mode ultrasound

CEUS

Contrast-enhanced ultrasound

CT

Computed tomography

EASL

European Association for the Study of the Liver

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

ICC

Intrahepatic cholangiocarcinoma

LI-RADS

Liver Imaging Reporting and Data System

MRI

Magnetic resonance imaging

Rim APHE

Rim-like arterial phase hyperenhancement

ROC

Receiver operating characteristic

TACE

Transarterial chemoembolization

Notes

Funding

This study has received funding by the National Natural Science Foundation of China (no. 81271578 and no. 81671698) and the Science and Technology Planning Project of Guangdong Province (no. 2017A020215099). These funders had no role in the design of the study, animal experiment, data collection and analysis, and interpretation of the data, or in writing of the manuscript.

Compliance with ethical standards

Guarantor

The guarantor of this study is Jianhua Zhou, from the Department of Ultrasound, Sun Yat-sen University Cancer Center.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

This study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

References

  1. 1.
    Massarweh NN, El-Serag HB (2017) Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control 24:107327481772924CrossRefGoogle Scholar
  2. 2.
    Choi SH, Lee SS, Kim SY et al (2017) Intrahepatic cholangiocarcinoma in patients with cirrhosis: differentiation from hepatocellular carcinoma by using gadoxetic acid-enhanced MR imaging and dynamic CT. Radiology 282:771–781CrossRefGoogle Scholar
  3. 3.
    Blechacz B, Gores GJ (2008) Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment. Hepatology 48:308–321CrossRefGoogle Scholar
  4. 4.
    Mavros MN, Economopoulos KP, Alexiou VG et al (2014) Treatment and prognosis for patients with intrahepatic cholangiocarcinoma. JAMA Surg 149:565CrossRefGoogle Scholar
  5. 5.
    Bridgewater J, Galle PR, Khan SA et al (2014) Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 60:1268–1289CrossRefGoogle Scholar
  6. 6.
    Zhang H, Yang T, Wu M, Shen F (2016) Intrahepatic cholangiocarcinoma: epidemiology, risk factors, diagnosis and surgical management. Cancer Lett 379:198–205Google Scholar
  7. 7.
    Joo I, Lee JM, Yoon JH (2018) Imaging diagnosis of intrahepatic and Perihilar cholangiocarcinoma: recent advances and challenges. Radiology 288:7–13CrossRefGoogle Scholar
  8. 8.
    Bohle W, Clemens PU, Heubach T, Zoller WG (2012) Contrast-enhanced ultrasound (CEUS) for differentiating between hepatocellular and cholangiocellular carcinoma. Ultraschall Med 33:E191–E195Google Scholar
  9. 9.
    Chen LD, Xu HX, Xie XY et al (2010) Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol 20:743–753Google Scholar
  10. 10.
    Liu GJ, Wang W, Lu MD et al (2015) Contrast-enhanced ultrasound for the characterization of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Liver Cancer 4:241–252Google Scholar
  11. 11.
    Chen LD, Xu HX, Xie XY et al (2008) Enhancement patterns of intrahepatic cholangiocarcinoma: comparison between contrast-enhanced ultrasound and contrast-enhanced CT. Br J Radiol 81:881–889CrossRefGoogle Scholar
  12. 12.
    Claudon M, Dietrich CF, Choi BI et al (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 34:11–29CrossRefGoogle Scholar
  13. 13.
    Xu HX, Chen LD, Liu LN, Zhang YF, Guo LH, Liu C (2012) Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination. Br J Radiol 85:1029–1037Google Scholar
  14. 14.
    Lu Q, Xue LY, Wang WP, Huang BJ, Li CX (2015) Dynamic enhancement pattern of intrahepatic cholangiocarcinoma on contrast-enhanced ultrasound: the correlation with cirrhosis and tumor size. Abdom Imaging 40:1558–1566Google Scholar
  15. 15.
    Li R, Zhang X, Ma KS et al (2013) Dynamic enhancing vascular pattern of intrahepatic peripheral cholangiocarcinoma on contrast-enhanced ultrasound: the influence of chronic hepatitis and cirrhosis. Abdom Imaging 38:112–119CrossRefGoogle Scholar
  16. 16.
    Yuan MX, Li R, Zhang XH et al (2016) Factors affecting the enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and their pathological correlations in patients with a single lesion. Ultraschall Med 37:609–618Google Scholar
  17. 17.
    Vilana R, Forner A, Bianchi L et al (2010) Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound. Hepatology 51:2020–2029CrossRefGoogle Scholar
  18. 18.
    Galassi M, Iavarone M, Rossi S et al (2013) Patterns of appearance and risk of misdiagnosis of intrahepatic cholangiocarcinoma in cirrhosis at contrast enhanced ultrasound. Liver Int 33:771–779CrossRefGoogle Scholar
  19. 19.
    Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefGoogle Scholar
  20. 20.
    European Association for Study of Liver, European Organisation for Research and Treatment of Cancer (2012) EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer 48:599–641Google Scholar
  21. 21.
    Jang H, Kim TK, Burns PN, Wilson SR (2015) CEUS: an essential component in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma. Eur J Radiol 84:1623–1635Google Scholar
  22. 22.
    Dietrich CF, Cui XW, Boozari B, Hocke M, Ignee A (2012) Contrast-enhanced ultrasound (CEUS) in the diagnostic algorithm of hepatocellular and cholangiocellular carcinoma, comments on the AASLD guidelines. Ultraschall Med 33 Suppl(1):S57–S66Google Scholar
  23. 23.
    Guo LH, Xu HX (2015) Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: controversy over the ASSLD guideline. Biomed Res Int 2015:1–5Google Scholar
  24. 24.
    Li R, Yuan MX, Ma KS et al (2014) Detailed analysis of temporal features on contrast enhanced ultrasound may help differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma in cirrhosis. PLoS One 9:e98612CrossRefGoogle Scholar
  25. 25.
    Han J, Liu Y, Han F et al (2015) The degree of contrast washout on contrast-enhanced ultrasound in distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Ultrasound Med Biol 41:3088–3095CrossRefGoogle Scholar
  26. 26.
    Kong WT, Wang WP, Huang BJ, Ding H, Mao F (2014) Value of wash-in and wash-out time in the diagnosis between hepatocellular carcinoma and other hepatic nodules with similar vascular pattern on contrast-enhanced ultrasound. J Gastroenterol Hepatol 29:576–580Google Scholar
  27. 27.
    Kono Y, Lyshchik A, Cosgrove D et al (2017) Contrast enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS®): the official version by the American College of Radiology (ACR). Ultraschall Med 38:85–86CrossRefGoogle Scholar
  28. 28.
    Terzi E, Iavarone M, Pompili M et al (2018) Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter retrospective study of 1,006 nodules. J Hepatol 68:485–492CrossRefGoogle Scholar
  29. 29.
    Lurie Y, Webb M, Cytter-Kuint R, Shteingart S, Lederkremer GZ (2015) Non-invasive diagnosis of liver fibrosis and cirrhosis. World J Gastroenterol 21:11567–11583Google Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouChina
  2. 2.Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouChina

Personalised recommendations