Factors Affecting the Enhancement Patterns of Intrahepatic Cholangiocarcinoma (ICC) on Contrast-Enhanced Ultrasound (CEUS) and their Pathological Correlations in Patients with a Single Lesion

Abstract

Purpose: To investigate the factors that influence the enhancement patterns of intrahepatic cholangiocarcinomas (ICC) on contrast-enhanced ultrasound (CEUS) and analyze the correlations between the enhancement patterns on CEUS and pathological findings.

Materials and Methods: Ninety-six patients with 96 pathologically confirmed ICCs underwent CEUS. CEUS images were retrospectively evaluated for tumor enhancement patterns in the arterial, portal and late phases. The arterial enhancement patterns were correlated with clinicopathological factors. The possible influencing factors were correlated with pathologic findings.

Results: Thirty-six patients with ICC demonstrated rim-like enhancement, and 60 exhibited non-rim-like enhancement in the arterial phase on CEUS. The incidence of non-rim-like-enhancing ICCs was higher in patients with cirrhosis and chronic viral hepatitis than patients with no chronic liver disease (p = 0.001). The sizes of the ICCs with homogeneous hyper-enhancement were significantly smaller than those with inhomogeneous hyper-enhancement (p = 0.007). Arterial non-rim-like-enhancing ICCs showed higher microvessel density (MVD) and arterial density (AD) and less fibrous stroma and necrosis than rim-like-enhancing ICCs. Arterial inhomogeneous-enhancing ICCs had lower MVD and AD and much more fibrous stroma and necrosis than homogeneous-enhancing ICCs.

Conclusion: The enhancement pattern of ICCs in the arterial phase on CEUS was affected by a liver cirrhosis and chronic viral hepatitis and tumor size. The amount of MVD, AD, fibrous stroma and necrosis in ICC tumors may be responsible for the difference in the enhancement patterns.

Zusammenfassung

Ziel: Suche nach Faktoren, die das Enhancement-Muster des intrahepatischen Cholangiokarzinoms (ICC) im kontrastverstärkten Ultraschall (CEUS) beeinflussen und mit den pathologischen Befunden korrelieren.

Material und Methoden: Bei 96 Patienten mit verifizierten ICC wurden die CEUS retrospektiv hinsichtlich der Tumor-Enhancement-Muster in der arteriellen portalen und späten Phase ausgewertet. Die Muster der arteriellen Phase wurden mit klinisch-pathologischen Daten verglichen und auf Korrelation mit den Pathologiebefunden verglichen.

Ergebnisse: Das Randenhancement in der arteriellen Phase fehlte bei 60 Tumoren, 36 mal war es nachweisbar. Bei Zirrhose und chronischer Virushepatitis fehlte es häufiger als bei Patienten ohne chronische Lebererkrankung (p = 0,001). Bei homogenem Hyperenhancement war die Größe der ICCs signifikant geringer als bei inhomogenem Enhancement (p = 0,007). ICCs mit fehlenden Randenhancement in der arteriellen Phase zeigten eine höhere Dichte an Mikrogefäßen („microvessel density“ MVD), größere Arteriendichte (AD) und weniger fibröses Stroma und weniger Nekrosen als ICCs mit Randenhancement. ICCs mit arteriellem inhomogenem Enhancement hattenniedrigere MVD und AD, sowie mehr fibröses Stroma und Nekrosen als ICCs mit homogenem Enhancement.

Schlussfolgerung: Die Kontrast-Enhancement-Muster des ICCs in der arteriellen CEUS-Phase wurden durch Leberzirrhose, chronische Virushepatitiden und von der Tumorgröße beeinflusst. Das Ausmaß an MVD, AD, fibrösem Stroma und Nekrose bei den ICC-Tumoren kann für die Unterschiede bei den Kontrast- Enhancement-Mustern verantwortlich sein.

Key words

influencing factors - intrahepatic cholangiocarcinoma - enhancement pattern - contrast-enhanced ultrasound - pathological findings

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