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Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors
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 ultrasoun...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218249/ https://www.ncbi.nlm.nih.gov/pubmed/37239893 http://dx.doi.org/10.3390/ijms24108548 |
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author | Ainora, Maria Elena Cerrito, Lucia Liguori, Antonio Mignini, Irene De Luca, Angela Galasso, Linda Garcovich, Matteo Riccardi, Laura Ponziani, Francesca Santopaolo, Francesco Pompili, Maurizio Gasbarrini, Antonio Zocco, Maria Assunta |
author_facet | Ainora, Maria Elena Cerrito, Lucia Liguori, Antonio Mignini, Irene De Luca, Angela Galasso, Linda Garcovich, Matteo Riccardi, Laura Ponziani, Francesca Santopaolo, Francesco Pompili, Maurizio Gasbarrini, Antonio Zocco, Maria Assunta |
author_sort | Ainora, Maria Elena |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10218249 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102182492023-05-27 Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors Ainora, Maria Elena Cerrito, Lucia Liguori, Antonio Mignini, Irene De Luca, Angela Galasso, Linda Garcovich, Matteo Riccardi, Laura Ponziani, Francesca Santopaolo, Francesco Pompili, Maurizio Gasbarrini, Antonio Zocco, Maria Assunta Int J Mol Sci Article 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. MDPI 2023-05-10 /pmc/articles/PMC10218249/ /pubmed/37239893 http://dx.doi.org/10.3390/ijms24108548 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Ainora, Maria Elena Cerrito, Lucia Liguori, Antonio Mignini, Irene De Luca, Angela Galasso, Linda Garcovich, Matteo Riccardi, Laura Ponziani, Francesca Santopaolo, Francesco Pompili, Maurizio Gasbarrini, Antonio Zocco, Maria Assunta Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors |
title | Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors |
title_full | Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors |
title_fullStr | Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors |
title_full_unstemmed | Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors |
title_short | Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors |
title_sort | multiparametric dynamic ultrasound approach for differential diagnosis of primary liver tumors |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218249/ https://www.ncbi.nlm.nih.gov/pubmed/37239893 http://dx.doi.org/10.3390/ijms24108548 |
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