Analysis of enhancement patterns and combined diagnosis of combined hepatocellular-cholangiocarcinoma: CEUS, CECT/MRI and tumor markers / 中华超声影像学杂志

ABSTRACT

Objective:To compare enhancement patterns of combined hepatocellular-cholangiocarcinoma (CHC) in CEUS and CECT/MRI and to explore the role of imaging, the discordance of imaging findings and tumor markers, differences in tumor markers in the diagnosis of CHC.Methods:Thirty-five CHCs from July 2011 to August 2019 in Third Central Hospital of Tianjin confirmed by pathological diagnosis were retrospectively reviewed. The enhancement patterns of CHCs on CEUS and CECT/MRI were compared. A combination of the discordance of CEUS and CECT/MRI, the discordance of elevated tumor markers and imaging findings and the discordance of tumor markers was applied to diagnose CHC.Results:About 62.9% and 37.1% lesions showed the HCC and ICC enhancement patterns on CEUS, while 48.6%, 31.4% and 20% lesions showed the HCC, ICC and CHC enhancement patterns, on CECT/MRI, respectively. For 12 lesions with a diameter≤3.0 cm, all of which presented HCC enhancement patterns on CEUS, and 91.7% lesions showed HCC enhancement pattern and 9.3% lesions showed ICC enhancement pattern on CECT/MRI, respectively. For 23 lesions with a size >3.0 cm, 43.5% and 56.5% of which showed the HCC and ICC enhancement patterns on CEUS, respectively. And 26.1%, 43.5% and 30.4% of the lesions showed the HCC, ICC and CHC enhancement patterns on CECT/MRI, respectively. If the discordance of CEUS and CECT/MRI, the discordance of image features and tumor markers, or simultaneous elevation of AFP and CA19-9, were used as diagnostic information, 78.6% of the lesions met at least one of the three criteria.Conclusions:CHCs show different enhancement patterns on CEUS and CECT/MRI. With the increase of size of tumors, the enhancement patterns of CHCs have changed from HCC-like to ICC-like or CHC-like. Combination of the discordance of CEUS and CECT/MRI, the discordance of imaging findings and tumor markers and differences in tumor markers can improve the detection rate of CHCs.