Objective To investigate the contrast-enhanced ultrasound (CEUS) imaging features of combined hepatocellular carcinoma (CHC) and to explore the differences in the CEUS images of different pathological types of CHC.
Methods The pathological and ultrasound images of patients with pathological-confirmed CHC were retrospectively analyzed. CEUS features were summarized and compared between different pathological types of CHC.
Results A total of 49 CHC patients were enrolled, including 27 cases of classic type and 22 cases with stem cell characteristics. There were 21 cases with HCC component as the main type, 25 cases with ICC component as the main type, and 3 cases with the same ratio of HCC and ICC. On gray-scale ultrasound, the interior of CHC lesions was mainly hypoechoic (79.6%), most of which presented as solid masses with unclear boundary and irregular shape. On CEUS, the enhancement patterns in the arterial phase of CHC lesions were overall uniform enhancement in 20 cases (40.8%), overall non-uniform enhancement in 23 cases (46.9%), and annular enhancement in 6 cases (12.2%). Significant attenuation was observed in 26 cases (53.1%) and mild resolution was observed in 16 cases (32.7%). The lesions mainly composed of hepatocellular carcinoma (HCC) were generally uniform (57.1%, 12/21) or inhomogeneous enhancement (42.9%, 9/21), while those mainly composed of intrahepatic cholangiocarcinoma (ICC) were generally inhomogeneous enhancement (48.0%, 12/25) or annular enhancement (24.0%, 6/25). The average attenuation time of classic CHC lesions was earlier than that of stem cell-associated CHC (P < 0.05), and there was no significant difference between the other CEUS findings of the two groups.
Conclusions There are differences in CEUS patterns of CHC lesions with different cell components. Attenuation time between classical CHC and CHC with stem cell characteristics is statisticallydifferent. CEUS is correlated with pathological characteristics of CHC.
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