Differentiation of intrahepatic cholangiocarcinoma from hepatocellular carcinoma in high-risk patients: A predictive model using contrast-enhanced ultrasound

World J Gastroenterol. 2018 Sep 7;24(33):3786-3798. doi: 10.3748/wjg.v24.i33.3786.


Aim: To develop a contrast-enhanced ultrasound (CEUS) predictive model for distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in high-risk patients.

Methods: This retrospective study consisted of 88 consecutive high-risk patients with ICC and 88 high-risk patients with HCC selected by propensity score matching between May 2004 and July 2016. Patients were assigned to two groups, namely, a training set and validation set, at a 1:1 ratio. A CEUS score for diagnosing ICC was generated based on significant CEUS features. Then, a nomogram based on the CEUS score was developed, integrating the clinical data. The performance of the nomogram was then validated and compared with that of the LR-M of the CEUS Liver Imaging Reporting and Data System (LI-RADS).

Results: The most useful CEUS features for ICC were as follows: rim enhancement (64.5%), early washout (91.9%), intratumoral vein (58.1%), obscure boundary of intratumoral non-enhanced area (64.5%), and marked washout (61.3%, all P < 0.05). In the validation set, the area under the curve (AUC) of the CEUS score (AUC = 0.953) for differentiation between ICC and HCC was improved compared to the LI-RADS (AUC = 0.742) (P < 0.001). When clinical data were added, the CEUS score nomogram was superior to the LI-RADS nomogram (AUC: 0.973 vs 0.916, P = 0.036, Net Reclassification Improvement: 0.077, Integrated Discrimination Index: 0.152). Subgroup analysis demonstrated that the CEUS score model was notably improved compared to the LI-RADS in tumors smaller than 5.0 cm (P < 0.05) but not improved in tumors smaller than 3.0 cm (P > 0.05).

Conclusion: The CEUS predictive model for differentiation between ICC and HCC in high-risk patients had improved discrimination and clinical usefulness compared to the CEUS LI-RADS.

Keywords: Hepatitis; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Ultrasonography.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / diagnostic imaging*
  • Bile Duct Neoplasms / pathology
  • Bile Ducts, Intrahepatic / diagnostic imaging
  • Bile Ducts, Intrahepatic / pathology
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Carcinoma, Hepatocellular / pathology
  • Cholangiocarcinoma / diagnostic imaging*
  • Cholangiocarcinoma / pathology
  • Contrast Media / administration & dosage
  • Diagnosis, Differential
  • Female
  • Humans
  • Image Enhancement / methods*
  • Liver / diagnostic imaging
  • Liver / pathology
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / pathology
  • Male
  • Middle Aged
  • Models, Biological
  • Nomograms
  • Retrospective Studies
  • Ultrasonography / instrumentation
  • Ultrasonography / methods
  • Young Adult


  • Contrast Media