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Patterns of appearance and risk of misdiagnosis of intrahepatic cholangiocarcinoma in cirrhosis at contrast enhanced ultrasound

Authors

  • Marzia Galassi,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Massimo Iavarone,

    1. 1st Division of Gastroenterology, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy
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  • Sandro Rossi,

    1. Division of Medicine 6, Policlinico San Matteo Foundation, IRCCS, Pavia, Italy
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  • Simona Bota,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
    2. Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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  • Sara Vavassori,

    1. 1st Division of Gastroenterology, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy
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  • Laura Rosa,

    1. Division of Medicine 6, Policlinico San Matteo Foundation, IRCCS, Pavia, Italy
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  • Simona Leoni,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Laura Venerandi,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Sara Marinelli,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Angelo Sangiovanni,

    1. 1st Division of Gastroenterology, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy
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  • Letizia Veronese,

    1. Division of Medicine 6, Policlinico San Matteo Foundation, IRCCS, Pavia, Italy
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  • Mirella Fraquelli,

    1. 1st Division of Gastroenterology, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy
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  • Alessandro Granito,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Rita Golfieri,

    1. Department of Digestive Disease and Internal Medicine, Radiology Unit, General and University S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Massimo Colombo,

    1. 1st Division of Gastroenterology, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Italy
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  • Luigi Bolondi,

    1. Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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  • Fabio Piscaglia

    Corresponding author
    • Division of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Correspondence

Fabio Piscaglia, Div. Internal MedicineVia Albertoni 15, 40138, Bologna, Italy

Tel.: +39 051 636 2542 / 68

Fax: +39 051 636 2725

e-mail: fabio.piscaglia@unibo.it

Abstract

Aim

Primary aim was to validate the percentage of intrahepatic cholangiocarcinomas (ICC) which have a contrast vascular pattern at contrast enhanced ultrasound (CEUS) at risk of misdiagnosis with hepatocellular carcinoma (HCC) and, secondary aim, to verify if any characteristics in the CEUS pattern helps to identify ICC.

Methods

All ICC on cirrhosis seen in three Italian centres (Bologna, Milan and Pavia) between 2003 and 2011, in which CEUS and at least another imaging technique (CT or MRI) had been performed, were retrospectively identified. Those patients with ICC size comparable to the early HCC stage (Milan criteria, considered as small ICC) were enrolled for this study. The enhancement pattern at CEUS was analysed and compared with CT or MRI.

Results

A total of 25 small ICC made this study group. CEUS was at risk of misdiagnosis of ICC for HCC in a significantly higher number of cases than in CT (performed in 24 ICC) (52% vs. 4.2%, P = 0.009) and MRI (11 ICC) (52% vs. 9.1%, P = 0.02). A different contrast pattern among all techniques was found in 6 of 10 ICC lesions submitted to the three imaging methods. In the arterial phase, ICC lacked global hyperenhacement in approximately 50% of cases at CEUS and the degree of intensity of wash-out in the late phase was marked in 24% of nodules.

Conclusions

CEUS misdiagnosed as HCC a significantly higher number of ICC lesions in cirrhotic patients than CT and MRI. However, some CEUS contrast features can help suspect ICC, especially in some cases with inconclusive CT or MRI.

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