The differential diagnosis of hepatic alveolar echinococcosis with intrahepatic cholangiocarcinoma by conventional and contrast-enhanced ultrasound

Abstract

Abstract: Objective To analyze the differential diagnosis of hepatic alveolar echinococcosis (HAE) and intrahepatic cholangiocarcinoma (ICC) by conventional ultrasound (CU) and contrast-enhanced ultrasound (CEUS). Methods From January 2017 to June 2021, 42 cases of HAE (31 males and 11 females, average age 55.7±12.2 years), and fifty-six ICC patients (37 males and 19 females, average age 38.8±14.0 years) were enrolled in this study. The performance of CU and CEUS and their combination in the diagnosis of HAE and ICC were compared by drawing receiver operating characteristic (ROC) curve and calculating the area Under the Curve (AUC). Results There were 34 cases (80.9%) and 8 cases (19.1%) of HAE, and 30 cases (53.6%) and 26 cases (46.4%) of ICC were found in the right lobe and left lobe of the livers, respectively, with statistical significant difference (χ²=7.941, P<0.05). 7 cases (16.7%), 29 cases (69.0%) and 6 cases (14.3%) of HAE patients, and 6 cases (10.7%), 18 cases (32.1%) and 32 cases (57.1%) of ICC patients were shown high, mixed and low echo lesions, respectively, the difference was statistically significant (χ²=18.825, P<0.05). Biliary dilatation was found in 2 cases (4.8%) of HAE and 16 cases (28.6%) of ICC patients, with statistical significance (P<0.05). There were 9 cases (21.4%) and 1 case (1.8%) of pseudo-cyst (χ²=10.106), and 20 cases (47.6%) and 0 cases (0) with calcification (χ²=33.504) in the HAE and ICC patients, respectively, the difference was all statistically significant (P<0.05). There were 27 cases (64.3%), 7 cases (16.7%) and 8 cases (19.0%) in HAE patients, and 46 cases (82.1%), 8 cases (14.3%) and 2 cases (3.6%) in ICC patients with high, equal and low echoic arterial phase, respectively, with statistically significant difference (χ²=-6.750, P<0.05). 36 cases (85.7%), 4 cases (9.5%), 2 cases (4.8%) and 1 case (2.4%) of HAE, and 6 cases (10.7%), 26 cases (46.4%), 13 cases (23.2%),and 11 cases (19.6%) of ICC patients had annular, heterogeneous, eccentric and centripetal enhancement, respectively, with statistically significant difference (χ²=53.172, P<0.05). There were 1 case (2.4%), 13 cases(30.9%)and 28 cases(66.7%)of HAE, and 0 cases (0), 1 case (1.8%) and 55 cases (98.2%) of ICC patients with high, equal and low echoic venous phase, respectively, the difference was statistically significant (χ²=18.445, P<0.05). 1 case (2.4%), 11 cases (26.2%) and 30 cases (71.4%) of HAE patients, and 0 cases (0), 2 cases (3.6%) and 54 cases (96.4%) of ICC patients with high, equal and low echoic delay, respectively, the difference was statistically significant (χ²=12.340, P<0.05). The peak time, fast-forward and fast-out of HAE patients were (192.7±46.2) s and 10 cases (23.8%), which was significantly different from those of (32.5±9.2)s and 41 cases (73.2%) in ICC patients (t=40.018, -14.125, P<0.05). The AUC value of diagnosing HAE by a combination of CU and CEUS was significantly higher than those by CU and CEUS alone (P< 0.05). Conclusion HAE and ICC can be accurately distinguished based on their typical characteristics of CU and CEUS.

Key words: Hepatic alveolar echinococcosis, Intrahepatic cholangiocarcinoma, conventional ultrasound, Contrast-enhanced ultrasound

WA Zeng-cheng, DU Ting, XU Hui-qing, QIAO Zhi-zhong. The differential diagnosis of hepatic alveolar echinococcosis with intrahepatic cholangiocarcinoma by conventional and contrast-enhanced ultrasound[J]. Chinese Hepatolgy, 2022, 27(5): 547-549.

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