The enhancement pattern of intrahepatic cholangiocarcinoma in the patients with cirrhosis by real-time contrast-enhanced ultrasound and contrast-enhanced helical CT

Objective To analyze the enhancement pattern by contrast-enhanced ultrasound (CEUS) and contrast-enhanced helical CT (CECT) of intrahepatic peripheral cholangiocarcinoma in the patients with cirrhosis. Methods Twelve patients with pathologically proven intrahepatic peripheral cholangiocarcinoma and cirrhosis were included in this study. Low mechanical index (mechanical index less than 0.2) of real-time CEUS was performed in 12 patients (11 patients with contrast pulse sequencing, CPS, 1 patient with pulse inversion harmonic) after 2.4ml bolus injection of contrast agent-SonoVue. CECT was performed by 16-slice helical CT and contrast agent Ultravist. The enhancement patterns of CEUS and CECT were analyzed. The diagnosis of CEUS and CECT were compared with histologic results before operation. Results The tumor was shown irregular rim-like hyperenhancement in 4 patients, heterogeneous hyperenhancement in 5 patients and homogeneous hyperenhancement in 3 patients in the arterial phase by CEUS. Nine patients were misdiagnosed as hepatocellular carcinoma, and only 3 patients were correctly diagnosed as cholangiocarcinoma. The tumor was presented as irregular rim-like hyperenhancement in only 2 patients, heterogeneous hyperenhancement in the other 10 patients in the arterial phase by CECT. Only 2 patients were correctly diagnosed as cholangiocarcinoma,and 10 patients were misdiagnosed as hepatocellular carcinoma by CECT. The diagnostic accuracy was only 25% by CEUS and 16.7% by CECT before operation. Conclusions Majority of intrahepatic cholangiocarcinoma in patients with cirrhosis may show an enhancement pattern similar to hepatocellular carcinoma by CEUS and CECT.