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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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.
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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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