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Abstract：
A correct differentiation between hepatocellular carcinoma (HCC) and intracellular cholangiocarcinoma (ICC) is essential for clinical management and prognostic prediction. However, non-invasive differential diagnosis between HCC and ICC remains highly challenging. Dynamic contrast-enhanced ultrasound (D-CEUS) with standardized software is a valuable tool in the diagnostic approach to focal liver lesions and could improve accuracy in the evaluation of tumor perfusion. Moreover, the measurement of tissue stiffness could add more information concerning tumoral environment. To explore the diagnostic performance of multiparametric ultrasound (MP-US) in differentiating ICC from HCC. Our secondary aim was to develop an US score for distinguishing ICC and HCC. Between January 2021 and September 2022 consecutive patients with histologically confirmed HCC and ICC were enrolled in this prospective monocentric study. A complete US evaluation including B mode, D-CEUS and shear wave elastography (SWE) was performed in all patients and the corresponding features were compared between the tumor entities. For better inter-individual comparability, the blood volume-related D-CEUS parameters were analyzed as a ratio between lesions and surrounding liver parenchyma. Univariate and multivariate regression analysis was performed to select the most useful independent variables for the differential diagnosis between HCC and ICC and to establish an US score for non-invasive diagnosis. Finally, the diagnostic performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis. A total of 82 patients (mean age ± SD, 68 ± 11 years, 55 men) were enrolled, including 44 ICC and 38 HCC. No statistically significant differences in basal US features were found between HCC and ICC. Concerning D-CEUS, blood volume parameters (peak intensity, PE; area under the curve, AUC; and wash-in rate, WiR) showed significantly higher values in the HCC group, but PE was the only independent feature associated with HCC diagnosis at multivariate analysis (p = 0.02). The other two independent predictors of histological diagnosis were liver cirrhosis (p < 0.01) and SWE (p = 0.01). A score based on those variables was highly accurate for the differential diagnosis of primary liver tumors, with an area under the ROC curve of 0.836 and the optimal cut-off values of 0.81 and 0.20 to rule in or rule out ICC respectively. MP-US seems to be a useful tool for non-invasive discrimination between ICC and HCC and could prevent the need for liver biopsy at least in a subgroup of patients.
摘要：
正确区分肝细胞癌（HCC）和细胞内胆管癌（ICC）对于临床管理和预后预测至关重要。然而,HCC和ICC的非侵入性鉴别诊断仍极具挑战性.具有标准化软件的动态对比增强超声（D-CEUS）是诊断局灶性肝脏病变的有价值的工具，可以提高评估肿瘤灌注的准确性。此外，组织硬度的测量可以增加更多关于肿瘤环境的信息.探讨多参数超声(MP-US)对ICC与HCC的鉴别诊断价值。我们的次要目标是制定区分ICC和HCC的美国评分。在2021年1月至2022年9月之间，在这项前瞻性单中心研究中招募了经组织学证实的HCC和ICC的连续患者。完整的美国评估，包括B模式，在所有患者中进行了D-CEUS和剪切波弹性成像（SWE），并比较了肿瘤实体之间的相应特征。为了更好的个体间可比性，将血容量相关的D-CEUS参数作为病变与周围肝实质的比值进行分析.进行了单变量和多变量回归分析，以选择最有用的独立变量用于HCC和ICC之间的鉴别诊断，并建立用于非侵入性诊断的US评分。最后,通过受试者工作特征(ROC)曲线分析评估评分的诊断性能.共82例患者(平均年龄±SD，68±11岁,55名男子)报名参加，包括44个ICC和38个HCC。HCC和ICC之间的基础US特征没有统计学上的显着差异。关于D-CEUS,血容量参数(峰值强度，PE；曲线下面积，AUC；和洗入率，WiR）在HCC组中显示出显着更高的值，但在多变量分析中，PE是唯一与HCC诊断相关的独立特征(p=0.02)。组织学诊断的其他两个独立预测因素是肝硬化（p<0.01）和SWE（p=0.01）。基于这些变量的评分对于原发性肝肿瘤的鉴别诊断非常准确，ROC曲线下面积为0.836，最佳临界值为0.81和0.20，分别排除或排除ICC。MP-US似乎是在ICC和HCC之间进行非侵入性区分的有用工具，并且至少可以防止在患者亚组中需要进行肝活检。
