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Imaging of Peripheral Cholangiocarcinoma With Low-Mechanical Index Contrast-Enhanced Sonography and SonoVue

Initial Experience

Departments of Medical Ultrasonics (H.-X.X., G.-J.L., X.-Y.X., Z.-F.X., Y.-L.Z., J.-Y.L.) and Hepatobiliary Surgery (M.-D.L.), The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

Address correspondence to Ming-De Lu, MD, DMSc, Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Rd 2, Guangzhou 510080, China. E-mail: lumd{at}21cn.com

Objective. The purpose of this study was to investigate the imaging findings of peripheral cholangiocarcinoma with low-mechanical index (MI) contrast-enhanced sonography. Methods. Eighteen nodules of peripheral cholangiocarcinoma proved by pathologic examination in 18 patients were evaluated with contrast-enhanced sonography. A low-MI real-time contrast-enhanced sonographic mode (ie, contrast pulse sequencing) and a sulfur hexafluoride-filled microbubble contrast agent (SonoVue [BR1]; Bracco SpA, Milan, Italy) were used. Results. On contrast-enhanced sonographic images, all 18 nodules (100%) of peripheral cholangiocarcinoma showed inhomogeneous enhancement during the arterial phase, and the emergence of nodule enhancement was earlier in 3 nodules (16.7%), simultaneous in 13 (72.2%), and later in 2 (11.1%), respectively, when compared with the adjacent liver tissue. During the arterial phase, 8 nodules (44.4%) showed irregular peripheral rimlike hyperenhancement, 2 (11.1%) showed inhomogeneous hyperenhancement, and 8 (44.4%) showed inhomogeneous hypoenhancement. In portal and late phases, all 18 nodules (100%) showed hypoenhancement. When contrast-enhanced sonography was added for analysis, the confidence levels of the investigators were improved in 15 (83.3%) of 18 nodules, and 17 (94.4%) of 18 peripheral cholangiocarcinomas were correctly characterized. Conclusions. The imaging findings of peripheral cholangiocarcinoma had some characteristics on low-MI contrast-enhanced sonography. Knowledge of these characteristics might be beneficial for improving the diagnostic performance of sonography in evaluating this entity.

Key Words: contrast media • liver • low mechanical index • peripheral cholangiocarcinoma • sonography

Abbreviations: CPS, contrast pulse sequencing • CT, computed tomography • FLL, focal liver lesion • HCC, hepatocellular carcinoma • MI, mechanical index • MRI, magnetic resonance imaging

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