According to a recent study published in Ultrasound in Medicine & Biology, dynamic contrast-enhanced ultrasound (DCE-US) with quantitative perfusion parameters might be beneficial in the preoperative differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) lesions in a noncirrhotic liver.

The study highlighted that both ICC and HCC lesions in a noncirrhotic liver might show some overlap of contrast-enhanced ultrasound (CEUS) features in the diagnostic process.

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However, DCE-US with quantitative parameters including rise time, mean transit time local, time to peak, fall time, wash-out area under the curve ratio, and wash-in and wash-out area under the curve ratio may prove to be valuable quantitative diagnostic parameters, they added.

The study included 30 patients with confirmed ICC and HCC lesions in noncirrhotic liver. Before surgery, all patients underwent CEUS examinations using either an Acuson Sequoia unit or a LOGIQ E20. The researchers analyzed features of the liver lesions using B-mode ultrasound (BMUS) and CEUS enhancement patterns. In addition, ICC and HCC groups were compared by analyzing the perfusion parameters through time-intensity curves (TIC) and using the student t-test or the Mann−Whitney U-test.

During the arterial phase (AP) of CEUS, ICC lesions exhibited various patterns of enhancement, including heterogeneous hyperenhancement (43.3%), heterogeneous hypoenhancement (6.7%), and rim-like hyperenhancement (50.0%). In contrast, all HCC lesions showed 100% heterogeneous hyperenhancement. Following the AP, most ICC lesions demonstrated wash-out during the AP phase (83.3%), while a smaller percentage exhibited wash-out during the portal venous phase (PVP) (15.7%). On the other hand, HCC lesions exhibited wash-out during the AP phase (41.7%), the PVP phase (41.7%), and a smaller portion showed late-phase wash-out (16.7%).

“Compared with those of HCC lesions, TICs of ICCs revealed earlier and lower enhancement during the AP, faster decline during the PVP, and reduced area under the curve,” the authors highlighted. Results also indicated that by combining all key parameters, the AUROC was 0.946, providing a differential diagnosis between ICC and HCC lesions in noncirrhotic liver with 86.7% sensitivity, 95.8% specificity, and 90.7% accuracy.

ICC and HCC are the two most common primary liver malignancies, accounting for approximately 85% of all primary liver malignant cases. Most HCCs develop in patients with liver cirrhosis, whereas ICCs typically arise in healthy liver parenchyma. The clinical guidelines provided by the American Association for the Study of Liver Diseases recommend different treatment strategies and offer distinct prognoses for HCC and ICC.

Multiphase contrast-enhanced computed tomography and magnetic resonance imaging have well-established roles in the noninvasive imaging diagnosis of ICC and HCC. However, the World Federation for Ultrasound in Medicine and Biology guidelines suggest that CEUS benefits cases with newly diagnosed indeterminate liver lesions.


Dong Y, Chen S, Möller K, et al. Applications of dynamic contrast-enhanced ultrasound in differential diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in noncirrhotic liver. Ultrasound Med Biol. Published online May 6, 2023.  doi:10.1016/j.ultrasmedbio.2023.03.026