Peripheral intrahepatic cholangiocarcinoma: ultrasound findings and differential diagnosis from hepatocellular carcinoma.
Colli A. Cocciolo M. Mumoli N. Cesarini L. Prisco A. Gaffuri I. Martinez E.
Divisione de Medicina, Ospedale 'C. Borella', Giussano (Milan), Italy.
OBJECTIVE: Peripheral cholangiocarcinoma may be more frequent than expected, and is usually asymptomatic until it is well advanced. Our purpose was to assess the accuracy of ultrasound in differential diagnosis. METHODS: We compared the sonographic findings of ten consecutive patients with histologically proven peripheral cholangiocarcinoma with those obtained in 26 consecutive patients with hepatocarcinoma detected in the same period. In every patient we performed an ultrasound-guided biopsy with a fine (22 gauge) cutting needle. RESULTS: In all patients with a final diagnosis of peripheral cholangiocarcinoma, the ultrasound scan disclosed multiple well-defined nodules with a hypoechoic or target pattern. Two patients had dilated intrahepatic bile ducts and suspected infiltration of the common duct. No patient had ascites. Only minimal alterations in laboratory examinations were found. Ultrasound-guided fine cutting needle biopsy yielded diagnostic material and allowed the definitive differential diagnosis. CONCLUSION: Peripheral cholangiocarcinoma even in Western countries may represent a significant proportion of all primary liver cancers. Due to non-specific symptomatology only intractable and far advanced cases were detected by means of sonography. Ultrasound findings did not differ from those found in cases of metastases from extrahepatic adenocarcinomas or hepatocarcinoma with multinodular pattern (10/26 in our series).
The significance of colour velocity and spectral Doppler ultrasound in the differentiation of liver tumours.
Kamalov IR. Sandrikov VA. Gautier SV. Tsirulnikova OM. Skipenko OG.
Research Centre of Surgery of Russian Academy of Medical Science, Abrikosovskii per., 2, 119874 Moscow, Russia.
OBJECTIVE: The aim of the work was to develop a standard protocol of colour velocity and spectral Doppler ultrasound (D.-US) of liver tumour vascularization and to estimate the value of this method in differentiation of liver tumours. METHODS: In 1994 and 1995, 68 patients with 128 primary and secondary liver tumours were observed. The final diagnosis was histologically verified. The diagnostic system Acuson 128 X/P 10M (Mountain View, CA) with 3.5 MHz convex abdominal probe was used. Qualitative features (vessel presence, vessel location and waveform of tumour vessel blood flow) and quantitative features (vessel quantity per cm2, vessel diameter, maximum velocity (Vmax), and resistance index (RI) of tumour artery, and Vmax of tumour portal vein) were included in the D.-US protocol. The differences in these features among various liver tumours were retrospectively analysed. RESULTS: The tumour vascularization was found more frequently in hepatocellular carcinoma (HCC) than in cavernous hemagioma (CavHA) or metastatic liver lesion (MLL) (P