AIM:To explore the diagnostic ability of contrast-enhanced ultrasound (CEUS) in distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). MATERIALS AND METHODS:PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for studies reporting thediagnostic accuracy of CEUS in differentiating ICC from HCC. The diagnostic ability of CEUS was assessed based on the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) with 95% confidence intervals (CIs). The methodologic quality was assessed by the QUADAS-2 tool. Subgroup analyses, meta-regression and investigation of publication bias were performed to identify the source of heterogeneity. RESULTS:A total of eight studies were included, consisting of 1,116 patients with HCC and 529 with ICC. The general diagnostic performance of CEUS in distinguishing ICC and HCC were as follows: pooled sensitivity, 0.92 (95% CI: 0.84–0.96); pooled specificity, 0.87 (95% CI: 0.79–0.92); pooled PLR, 7.1 (95% CI: 4.1–12.0); pooled NLR, 0.09 (95% CI: 0.05–0.19); pooled DOR, 76 (95% CI: 26–220) and AUC, 0.95(95% CI: 0.93–0.97). Different liver background may be a potential factor that influenced the diagnostic accuracy of CEUS according to the subgroup analysis, with the pooled DOR of 89.67 in the mixed liver background group and 46.87 in the cirrhosis group, respectively. Six informative CEUS features that may help differentiate HCC from ICC were extracted. The three CEUS features favoring HCC were arterial phase hyperenhancement(APHE), mild washout and late washout (>60s); the three CEUS favoring ICC were arterial rim enhancement, marked washout and early washout(<60s). No potential publication bias was observed. CONCLUSION:CEUS showed great diagnostic ability in differentiating ICC from HCC, which may be promising for noninvasive evaluation of these diseases.

中文翻译：

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使用对比增强超声鉴别肝细胞癌和肝内胆管癌：系统评价和荟萃分析

目的：探讨对比增强超声（CEUS）对肝内胆管癌（ICC）与肝细胞癌（HCC）的鉴别诊断能力。材料和方法：系统地搜索了 PubMed、EMBASE、Cochrane Library 和 Web of Science，以寻找报告 CEUS 在区分 ICC 与 HCC 中诊断准确性的研究。CEUS 的诊断能力是根据汇总的敏感性、特异性、诊断优势比 (DOR)、阳性似然比 (PLR)、阴性似然比 (NLR) 和曲线下面积 (AUC) 以及 95% 置信区间 (CI) 来评估的）。方法学质量由 QUADAS-2 工具评估。进行了亚组分析、荟萃回归和发表偏倚调查，以确定异质性的来源。结果：共纳入 8 项研究，包括 1,116 名 HCC 患者和 529 名 ICC 患者。CEUS 在区分 ICC 和 HCC 方面的一般诊断性能如下：汇总敏感性，0.92（95% CI：0.84-0.96）；汇总特异性，0.87（95% CI：0.79–0.92）；合并 PLR，7.1（95% CI：4.1–12.0）；合并 NLR，0.09（95% CI：0.05–0.19）；汇总 DOR，76（95% CI：26–220）和 AUC，0.95（95% CI：0.93–0.97）。根据亚组分析，不同的肝脏背景可能是影响 CEUS 诊断准确性的潜在因素，混合肝脏背景组和肝硬化组的合并 DOR 分别为 89.67 和 46.87。提取了可能有助于区分 HCC 和 ICC 的六个信息丰富的 CEUS 特征。有利于 HCC 的三个 CEUS 特征是动脉期高强化（APHE）、轻度洗脱和晚期洗脱（>60s）；CEUS 有利于 ICC 的三个是动脉边缘增强，显着冲洗和早期冲洗（<60s）。未观察到潜在的发表偏倚。结论：CEUS在鉴别ICC与HCC方面表现出很强的诊断能力，有望用于这些疾病的无创评估。