Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2020; 26(9): 960-972
Published online Mar 7, 2020. doi: 10.3748/wjg.v26.i9.960
Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound
Xiao-Feng Wu, Xiu-Mei Bai, Wei Yang, Yu Sun, Hong Wang, Wei Wu, Min-Hua Chen, Kun Yan
Xiao-Feng Wu, Xiu-Mei Bai, Wei Yang, Hong Wang, Wei Wu, Min-Hua Chen, Kun Yan, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing 100142, China
Yu Sun, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
Author contributions: All authors performed the research; Wu XF, Bai XM and Yang W wrote the manuscript; Wu XF, Bai XM and Wang H performed the color contrast ultrasound and data analysis; Yang W, Wu W, Chen MH, and Yan K conceived and designed the study, performed the examinations, and the data analysis; Sun Y performed the pathologic analysis. Wu XF and Bai XM contributed equally to this work.
Supported by Capital Medical Development Program, No. 2018-2-2154; and National Natural Science Foundation of China, No. 81773286.
Institutional review board statement: This study was reviewed and approved by the Peking University School of Oncology
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei Yang, MD, Professor, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Number 52 Fucheng Road, District of Haidian, Beijing 100142, China. 13681408183@163.com
Received: November 28, 2019
Peer-review started: November 28, 2019
First decision: December 23, 2019
Revised: January 12, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: March 7, 2020
Processing time: 99 Days and 0.3 Hours
ARTICLE HIGHLIGHTS
Research background

In clinical practice, the diagnosis is sometimes difficult with contrast-enhanced ultrasound (CEUS) when the case has an atypical perfusion pattern. Color parametric imaging (CPI) is an analysis software for CEUS with better detection of temporal differences in CEUS imaging using arbitrary colors. It measures the differences in arrival time of the contrast agent in lesions so that the perfusion features of atypical hemangioma and colorectal cancer liver metastasis can be distinguished.

Research motivations

The motivation of this study was to evaluate the role of CPI in the differential diagnosis of atypical hemangioma from liver metastases and the diagnostic performance by staff and resident radiologists. The patients with atypical hemangioma would be benefited by avoiding invasive test or even surgical resection. Furthermore, a junior radiologist can be more confident in the differential diagnosis of liver lesions by CPI.

Research objectives

To evaluate the role of a novel type of CPI of CEUS in the differential diagnosis of atypical hemangioma from liver metastases in patients with a history of colorectal cancer.

Research methods

All enrolled patients received ultrasound, CEUS and CPI examinations. Resident and staff radiologists independently and retrospectively reviewed CEUS and CPI images. Two sets of criteria were assigned: (1) Routine CEUS alone; and (2) CEUS and CPI. The diagnostic sensitivity, specificity, accuracy and receiver operating characteristic (ROC) curve of resident and staff radiologists were analyzed.

Research results

The following CPI features were significantly different between liver hemangioma and liver metastases analyzed by staff and resident radiologists: Peripheral nodular enhancement (65%-70.0% vs 4.5%-13.6%, P < 0.001, P = 0.001), mosaic/chaotic enhancement (5%-10% vs 68.2%-63.6%, P < 0.001, P < 0.001) and feeding artery (20% vs 59.1-54.5%, P = 0.010, P = 0.021). CPI imaging offered significant improvements in detection rates compared with routine CEUS signs in both resident and staff groups.

Research conclusions

CPI could provide specific information on the hemodynamic features of liver lesions and help to differentiate atypical hemangioma from liver metastases, for both staff and resident radiologists. CPI is useful especially for radiologists with less CEUS experience.

Research perspectives

In this study, a novel type of color contrast enhanced ultrasound provided supplemental information for differential diagnosis between atypical hemangioma and liver metastasis. This technique is safe and effective in clinical practice. However, to confirm the performance of this new imaging method, studies on a larger sample set are required.