Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2019; 11(5): 436-448
Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.436
Analysis of B-ultrasound and contrast-enhanced ultrasound characteristics of different hepatic neuroendocrine neoplasm
Xiao-Ning Kang, Xiao-Yu Zhang, Jie Bai, Zun-Yi Wang, Wen-Jie Yin, Li Li
Xiao-Ning Kang, Li Li, Department of Second Ultrasound, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
Xiao-Yu Zhang, Jie Bai, Zun-Yi Wang, Department of Third Oncology, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
Wen-Jie Yin, Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
Author contributions: Kang XN, Zhang XY, and Li L designed the research; Kang XN, Bai J, and Wang ZY performed the research; Li L and Yin WJ contributed new reagents/analytic tools; Kang XN, Bai J, and Zhang XY analyzed the data; and Kang XN, Zhang XY, and Li L wrote the paper.
Institutional review board statement: The study was approved by the ethics committee of Cangzhou Central Hospital.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Li Li, MD, Chief Physician, Department of Second Ultrasound, Cangzhou Central Hospital, No. 16 Xinhua West Road, Yunhe District, Cangzhou 061001, Hebei Province, China. lilijobdoc@126.com
Telephone: +86-317-2075790
Received: January 30, 2019
Peer-review started: January 30, 2019
First decision: March 14, 2019
Revised: March 19, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 15, 2019
Abstract
BACKGROUND

Hepatic neuroendocrine neoplasm (hNEN) is a highly heterogeneous tumor. The exact identification of the source and malignant degree of hNEN is important. However, there is a lack of information regarding diagnosis of hNEN with imaging. In addition, no studies have compared the imaging between hNEN and hepatocellular carcinoma (HCC) and among different sources and malignant degrees of hNEN.

AIM

To compare the ultrasound characteristics between hNEN and HCC and among different sources and malignant degrees of hNEN.

METHODS

A total of 55 patients with hNEN were recruited and defined as the hNEN group. Among them, 35 cases of hNET were defined as the hNET group. Twenty cases of hepatic neuroendocrine carcinoma (hNEC) were defined as the hNEC group. Among the 55 lesions, 29 were transferred from the pancreas, 20 were from the gastrointestinal tract, and six were from other sites. In total, 55 patients with HCC were recruited and defined as the HCC group. The characteristic differences of B-mode ultrasound and contrast-enhanced ultrasound (CEUS) between hNEN and HCC and among different sources and malignant degrees of hNEN were compared.

RESULTS

In the hNEN group, the proportions of multiple liver lesions, unclear borders, and high echo lesions were higher than those in the HCC group. The proportions of non-uniform echo and peripheral acoustic halo were lower than those in the HCC group (P < 0.05). The washout to iso-enhancement time and washout to hypo-enhancement time were lower than those in the HCC group (P < 0.05). The characteristics of B-ultrasound and CEUS among different sources of hNEN were similar, and the differences were not statistically significant (P > 0.05). B-mode ultrasound characteristics of hNET and hNEC were similar. The proportions of low enhancement at portal venous phase, non-uniform enhancement forms, and combined tumor vasculature in the hNEC group were larger than those in the hNEN group (P < 0.05).

CONCLUSION

Compared with HCC, hNEN showed multiple intrahepatic lesions, uniform high echo, uniform high enhancement at arterial phase, and rapid washout. Low enhancement at portal venous phase, overall non-uniform enhancement form, and the proportion of combined tumor vasculature in hNEC were larger than those in hNET.

Keywords: Hepatic neuroendocrine neoplasm, Hepatic neuroendocrine tumor, Hepatic neuroendocrine carcinoma, B-ultrasound, Contrast-enhanced ultrasound

Core tip: Clinically, hepatic neuroendocrine neoplasm (hNEN) is rare, and few reports are currently available on the imaging diagnosis of hNENs. In this study, by comparing hNEN and hepatocellular carcinoma, hNEN from different sources, and differentiation, it was found that the ultrasound characteristics of hNEN are mostly multiple, uniform hyperechoic masses. The enhancement at the arterial phase was mostly uniform and high, and the washout was rapid compared with hepatocellular carcinoma. Compared with hepatic neuroendocrine tumor, the enhancement at the portal venous phase of hepatic neuroendocrine carcinoma was low, and the enhancement form was non-uniform.