Contrast-enhanced ultrasound in association with serum biomarkers for differentiating combined hepatocellular-cholangiocarcinoma from hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Figure 3 LR-M nodule in a 55-year-old woman with chronic hepatitis B. A: A hypoechoic nodule with a diameter of 3.4 cm in the left lobe of the liver was homogeneously hyper-enhanced (arrow) in the arterial phase; B: Early washout was observed at 32 s after injection of contrast agent (SonoVue; Bracco); C: Hypo-enhancement of the whole nodule was demonstrated in the late phase. Serologic data indicated normal alpha-fetoprotein and carbohydrate antigen 19-9 levels. The nodule was assessed as non-combined hepatocellular-cholangiocarcinoma lesion according to the diagnostic criteria; D: The nodule was proved to be hepatocellular carcinoma by pathology (hematoxylin and eosin staining; magnification, × 100).