The Value Of Contrast Enhanced Ultrasound LI -RADS Combined With Serum Tumor Markers In The Differenrial Diagnosis Of Intrahepatic Cholangiocarcinomaand Hepatocellular Carcinoma

Objective To explore the value of the contrast enhanced ultrasound(CEUS)liver imaging and data management system(LI-RADS)classification combined with serum tumor markers in the differential diagnosis of intrahepatic cholangiocarcinoma(ICC)and hepatocellular carcinoma(HCC).Methods Pathologically confirmed of 35 cases of ICC and 42 cases of HCC were investigated retrospectively.The CEUS imaging characteristics of ICC and HCC and the expression levels of CA19-9,CA125,CA153,CEA,AFP and PIVKA-II were compared.Receiver operating characteristic(ROC)curves were used to assess the efficacy of the six tumor markers and the three features of CEUS LR-M in the single or joint application in the differential diagnosis between ICC and HCC.Results Nine of the fifteen CEUS features were significantly different between ICC and HCC.Among them,LR-M features(rim enhancement,earlywashout in portal phase,marked washout)had higher OR(odds ratio)values,which were 15.438,29.700 and 89.583,respectively.For ICC,the area under the ROC curve(AUC)of joint detection of CA19-9,CA125,CA153 and CEA was0.877(95% CI 0.781-0.942).The AUC of joint detection of AFP and PIVKA-II for the diagnosis of HCC was 0.808(95% CI 0.708-0.909).The combination of CA19-9,CA125,CA153,CEA and LR-M features has the best diagnostic efficiency in ICC.The AUC is 0.968(0.900-0.995),with the sensitivity of94.3% and the specificity of 97.6%.Conclusions ICC and HCC have a certain degree of difference in the CEUS enhancement mode.The combination of CEUS LR-M features and serum tumor markers has high diagnostic performance and can be used for ICC diagnosis and differential diagnosis between ICC and HCC.