Contrast-enhanced ultrasound features of hepatic sarcomatoid carcinoma different from hepatocellular carcinoma

Qiannan Zhao; Zhengbiao Ji; Yanling Chen; Kun Wang; Yijie Qiu; Xiaofan Tian; Yuli Zhu; Hong Qin; Hong Han; Haixia Yuan; Yi Dong; Wenping Wang

doi:10.3233/CH-231944

Contrast-enhanced ultrasound features of hepatic sarcomatoid carcinoma different from hepatocellular carcinoma

Clin Hemorheol Microcirc. 2023 Dec 27. doi: 10.3233/CH-231944. Online ahead of print.

Authors

Qiannan Zhao¹, Zhengbiao Ji¹, Yanling Chen¹, Kun Wang², Yijie Qiu¹, Xiaofan Tian¹, Yuli Zhu¹, Hong Qin¹, Hong Han¹, Haixia Yuan^{1

3}, Yi Dong^{1

4}, Wenping Wang^{1

5}

Affiliations

¹ Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China.
³ Department of Ultrasound, Zhongshan Hospital, Fudan University (Qingpu Branch), Shanghai, China.
⁴ Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵ Shanghai Institute of Imaging Medicine, Shanghai, China.

PMID: 38160348
DOI: 10.3233/CH-231944

Abstract

Background: Hepatic sarcomatoid carcinoma (HSC) is a rare malignancy of the liver. The ultrasound and clinical features of HSC have not been determined.

Objective: To investigate and compare the ultrasound and clinical features of HSC and hepatocellular carcinoma (HCC), and to reveal the valuable features of HSC.

Methods: The ultrasound features and clinical data of pathologically proven HSC (n = 37) were compared with HCC (n = 92) in a matching ratio of 1:4 using the propensity score (age, gender and tumor size).

Results: The HSC patients were more likely to accompany with clinical symptoms and vascular invasion than HCC patients (40.5% vs 17.4%, 24.3% vs 6.5%, P < 0.05). The size of HSCs was significantly larger than that of HCCs (P < 0.05). The proportion of patients with elevated alpha-fetoprotein was significantly lower in HSC (35.1% vs 54.3%, P < 0.05). On gray-scale ultrasound images, the HSCs were more likely to demonstrate as indistinct margin and irregular shape lesions compared to HCCs (78.4% vs 48.8% ; 70.3% vs 23.9%, P < 0.05). Under color Doppler flow imaging (CDFI), the blood flow signals were more frequently detected in HSC lesions (75.7% vs 56.5%, P < 0.05). Resistance index (RI) was higher in HSCs than in HCCs [0.78 (0.70,0.82) vs 0.70 (0.62,0.76), P < 0.05]. On contrast-enhanced ultrasound (CEUS), HSCs mainly showed entirety heterogeneous hyper-enhancement (48.6%), entirety homogeneous enhancement (18.9%), peripheral and internal septal enhancement (18.9%). The incidence of non-enhanced areas inside HSC lesions was higher than that inside HCC lesions (56.8% vs 31.5%, P < 0.05). During the portal venous and late phases, most of the lesions revealed hypo-enhancement in both groups, whereas earlier washout was observed in HSCs [43.0 s (30.5,58.0) vs 60.0 s (46.3,100.0), P < 0.05].

Conclusions: CEUS features are useful in preoperative and non-invasive differentiation of hepatic sarcomatoid carcinoma and hepatocellular carcinoma.

Keywords: Hepatic sarcomatoid carcinoma (HSC); color Doppler flow imaging (CDFI); contrast-enhanced ultrasound (CEUS); gray-scale ultrasound; hepatocellular carcinoma (HCC).