ENHANCEMENT PATTERNS OF INTRAHEPATIC CHOLANGIOCELLULAR CARCINOMA ON CEUS - MONOCENTRIC OBSERVATIONAL STUDY.

Objective: This study aimed to evaluate the enhancement pattern of cholangiocellular carcinoma (CCC) on contrast enhanced ultrasound (CEUS). Methods: This observational retrospective study included 50 patients diagnosed with CCC between 2010-2018. The final diagnosis of CCC was established by an imaging method (contrast enhanced CT or MRI) or biopsy. All 50 patients with CCC were examined by CEUS (22 men, 38 women, mean age 64.3±10.9 years); only 5 patients had liver cirrhosis and 2 patients with chronic hepatopathy with severe fibrosis. CEUS was considered conclusive for CCC if a typical pattern was present (EFSUMB criteria). Results: In the arterial phase the enhancement patters were: a) Rim-like enhancement: irregular peripheral hyper-enhancement and nonenhancing regions 18/50 cases (36%); b) Homogeneous hyperenhancement in 11/50 cases (22%); c) Heterogeneous hyperenhancementmixed irregular hyper-enhancement in both the peripheral and central parts of the lesion and nonenhancing regions in 12/50 cases (24%); d) Isoenhancement in 2/50 cases (4%); e) Hypoenhancement in 7/50 cases (14%). In the portal phase washout was observed in 34/50 (68%) cases, isoenhancement in 7/50 cases (14%), hypoenhacement in 7/50 cases (14%) and hyperenhancing pattern in 2/50 (4%) cases. In the late phase washout was observed in 40/50 (80%) cases, hypoenhacement in 8/50 cases (16%), isoenhancement in 1/50 cases (2%) and hyperenhancing pattern in 1/50 cases (2%). In 44% (22/50 cases) CEUS was conclusive for the diagnosis of CCC, 25 lesions were inconclusive on CEUS and 3 (6%) lesions were misdiagnosed. After CEUS examination all 25 inconclusive lesions were classified as malignant. Conclusions: 60% of CCC cases had rim-like and heterogeneous enhancement in the arterial phase. Washout was present in the late vascular phase in 80% of cases. After CEUS examination a conclusive result for the diagnosis of CCC was obtained in 44% cases. All inconclusive lesions on CEUS were classified as malignant. [ABSTRACT FROM AUTHOR]