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Ultraschall Med 2015; 36(02): 132-139
DOI: 10.1055/s-0034-1399147
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

CEUS in Hepatocellular Carcinoma and Intrahepatic Cholangiocellular Carcinoma in 320 Patients – Early or Late Washout Matters: A Subanalysis of the DEGUM Multicenter Trial

Kontrastverstärkter Ultraschall bei 320 Patienten mit hepatozellulären und intrahepatischen cholangiozellulären Karzinomen – frühes oder spätes Auswaschen macht den Unterschied. Subanalyse der DEGUM Multicenter Studie
D. Wildner
1   Department of Internal Medicine 1, University Hospital Erlangen, Germany
,
T. Bernatik
2   Department of Internal Medicine, District Hospital Ebersberg, Germany
,
C. Greis
3   Department of Clinical Research, Bracco Imaging Deutschland, Konstanz, Germany
,
K. Seitz
4   Department of Medicine, District Hospital Sigmaringen, Germany
,
M. F. Neurath
1   Department of Internal Medicine 1, University Hospital Erlangen, Germany
,
D. Strobel
1   Department of Internal Medicine 1, University Hospital Erlangen, Germany
› Institutsangaben
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Publikationsverlauf

03. September 2014

23. Januar 2015

Publikationsdatum:
26. März 2015 (online)

Auch verfügbar auf
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Abstract

Purpose: 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.

Materials and 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 %).

Conclusion: 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.

Zusammenfassung

Ziel: Ziel dieser Arbeit war es, die Vaskularisationsmuster von hepatozellulären (HCC) und intrahepatischen cholangiozellulären Karzinomen (ICC) in der Kontrastmittelsonografie (CEUS) zu vergleichen. Es handelt sich um eine Subanalyse der DEGUM – Multizenterstudie zum Stellenwert der Kontrastmittelsonografie von B-Bild-morphologisch unklaren Leberläsionen.

Material und Methoden: Aus der Datenbank der DEGUM Multizenterstudie (1349 Patienten) wurden alle histologisch gesicherten HCC (n = 278) und ICC (n = 42) analysiert. Dazu wurden die Vaskularisationsmuster und das Kontrastmittelenhancement der hämodynamisch relevanten Perfusionsphasen (arteriell, portal-venös, Spätphase) verglichen.

Ergebnisse: Bei 214/278 Patienten mit HCC (76.9 %) und bei 7/42 Patienten mit ICC (16.7 %) lag eine Leberzirrhose vor. In CEUS zeigten HCC im Vergleich zu ICC häufiger eine arterielle Hypervaskularisation (HCC: Tumorzentrum: 60.3 %; Tumorperipherie: 75 %. ICC: Tumorzentrum 16.7 %; Tumorperipherie 40.5 %). ICC zeigten in der portalvenösen Phase häufiger ein Hypoenhancement (Zentrum der Läsion: ICC: 85.8 % vs. HCC: 49.8 %. Peripherie: ICC 66.7 % vs. HCC 32.6 %). In der Spätphase zeigten die Mehrzahl der HCC (75 %) und nahezu alle ICC (92.9 %) ein Auswaschen des Kontrastmittels.

Schlussfolgerung: Die Differentialdiagnose eines ICC bei Leberzirrhose ist selten. In der CEUS zeigen HCC und ICC unterschiedliche Vaskularisationsmuster. Charakteristisch für ein HCC sind die globale arterielle KM-Aufnahme und ein langsames Auswaschen des Kontrastmittels in der Spätphase. Charakteristisch für ICC ist die initiale Kontrastmittelanflutung vorwiegend in der Tumorperipherie mit Auswaschen des Kontrastmittels ab der frühen portalvenösen Phase.

Key words

contrast-enhanced ultrasound - hepatocellular carcinoma - intrahepatic cholangiocellular carcinoma - enhancement pattern - characterization
 

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