Dynamic Contrast-Enhanced Ultrasound (DCE-US) for the Characterization of Hepatocellular Carcinoma and Cholangiocellular Carcinoma

Abstract

Purpose: In a prospective study, we compared the different perfusion kinetics of HCC and ICC using dynamic contrast-enhanced ultrasound (DCE-US).

Materials and Methods: Patients with proven HCC and ICC were included. Three-minute video clips of CEUS examinations (CPS – low MI mode) after a bolus injection of 1.2 ml SonoVue^® were recorded and analyzed with quantification software (VueBox^®). Parameters for the arterial contrast enhancement [rise time (RT), time-to-peak (TTP)] towards portal venous contrast enhancement [mean transit time (local) (mTTl) and fall time (FT)] were quantified. Furthermore, contrast wash-out after peak enhancement (PE) (40 s, 80 s, 100 s and 120 s after PE) was compared between HCC and ICC.

Results: 43 patients with proven HCC (n = 23 HCC; cirrhosis n = 16) and ICC (n = 20 ICC; Cirrhosis n = 6) were examined. No statistical difference of the arterial DCEUS parameters was found between HCC and ICC. Contrast enhancement of the portal venous and late phases showed significantly lower values in the ICC group indicating early wash-out of the contrast agent: mTTl (p = 0.0209): HCC 118.4 s (SD± 88.4); ICC 64.8 s (SD± 49.7). FT (p = 0.0433): HCC 42.5 s (SD± 27.7); ICC 27.7 s (SD± 16.2). The percental loss of intensity at a definite time point after PE was significantly higher in ICC than in HCC lesions.

Conclusion: DCE-US is able to detect and quantify differences in perfusion kinetics between HCC and ICC. Whereas arterial contrast enhancement patterns may overlap between HCC and ICC, a timed characterization of wash-out kinetics may offer an additional tool to characterize HCC and ICC. The presence of a rapid loss of signal intensity in the early portal venous phase is significantly higher in ICC than in HCC lesions.

Zusammenfassung

Ziel: Prospektiver Vergleich der Perfusionskinetik von HCC und ICC mittels quantifizierender Kontrastmittelsonografie (DCE-US).

Material und Methoden: Eingeschlossen wurden Patienten mit gesichertem HCC oder ICC. Videoclips der CEUS nach Bolusinjektion von 1,2 ml SonoVue^® (CPS – low MI Mode) wurden kontinuierlich über 3 Minuten aufgezeichnet, die Kontrastierungsparameter der arteriellen und portalvenösen Phase [Rise-Time (RT), Time-To-Peak (TTP), mean Transit Time (local) (mTTl) und Fall-Time (FT)] wurden mittels Quantifizierungs-Software analysiert. Zu definierten Zeitpunkten wurde der Intensitätsabfall nach Erreichen der Maximalintensität [Peak-Enhancement (PE)] zwischen HCC und ICC verglichen.

Ergebnisse: Es wurden 43 Patienten mit gesichertem HCC (n = 23; Zirrhose n = 16) bzw. ICC (n = 20; Zirrhose n = 6) untersucht. Die Mittelwerte der arteriellen DCE-US-Parameter von HCC versus ICC unterschieden sich nicht signifikant. Die DCE-US Parameter der portalvenösen Phase und Spätphase waren in der ICC-Gruppe signifikant niedriger (früheres Wash-Out in der ICC-Gruppe). mTTl (p = 0,0209): HCC 118,4 s (SD± 88,4); ICC 64,8 s (SD± 49,7). FT (p = 0,0433): HCC 42,5 s (SD± 27,7); ICC 27,7 s (SD± 16,2). Der Abfall des Kontrastmittelenhancement nach Erreichen der Spitzenintensität (PE) war in der ICC-Gruppe signifikant größer verglichen mit der HCC-Gruppe.

Schlussfolgerung: In der Charakterisierung von HCC und ICC kann DCE-US signifikante Vaskularisationsunterschiede quantitativ erfassen. Während die arteriellen Vaskularisationsparameter beider Tumorentitäten überlappen, ist eine statistisch signifikante Unterscheidung zwischen HCC und ICC durch die definierte Auswaschkinetik möglich. Das Vorliegen eines raschen Intensitätsverlusts in der frühen portalvenösen Phase zeigt sich signifikant häufiger bei ICC verglichen mit HCC.

Key words

dynamic contrast-enhanced ultrasound (DCEUS) - quantification - hepatocellular carcinoma - cholangiocellular carcinoma

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