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

Figure 4 LR-M nodule in a 46-year-old man with chronic hepatitis B. A: A hypoechoic nodule with a diameter of 3.9 cm in the right lobe of the liver was heterogeneously hyper-enhanced (arrow) in the arterial phase; B: Early washout (30 s) of the contrast agent was observed (arrow); C: Hypo-enhancement of the nodule (arrow) in the late phase was shown at contrast-enhanced ultrasound. The patient had both normal alpha-fetoprotein and carbohydrate antigen 19-9 levels. The lesion was classified as non-combined hepatocellular-cholangiocarcinoma lesion according to the diagnostic criteria; D: Intrahepatic cholangiocarcinoma and cirrhosis of the surrounding liver were confirmed by pathology (hematoxylin and eosin staining; magnification, × 100).