Hepatitis Virus Infection Predicts Heterogeneous Enhancement Patterns in Intrahepatic Cholangiocarcinoma on Contrast-Enhanced Ultrasound: A Retrospective Radiological Cohort Study.

Abstract

Background: Chronic hepatitis is a significant risk factor for intrahepatic cholangiocarcinoma (ICC). Accurate identification of hepatitis-associated ICC is critical for optimizing clinical management. This study aimed to differentiate hepatitis-associated ICC from non-hepatitis cases by integrating clinical and contrast-enhanced ultrasound (CEUS) features.

Methods: Using histopathology as the gold standard, a retrospective analysis was conducted on ICC patients who underwent CEUS at the Second Hospital of Lanzhou University (July 2020 to February 2025). Patients were stratified into hepatitis (n = 36) and non-hepatitis cirrhosis (n = 82) groups. Baseline clinical and ultrasonographic characteristics were compared. Independent predictors of hepatitis-associated ICC were identified via univariate and multivariate logistic regression, with diagnostic performance evaluated by receiver operating characteristic (ROC) curve analysis.

Results: Compared to non-hepatitis ICC (69.5%), hepatitis-associated ICC (30.5%) showed significant differences in age (p = 0.001), male predominance (p = 0.001), elevated alpha-fetoprotein (AFP, p = 0.002), carbohydrate antigen 19-9 (CA19-9, p = 0.010), absence of intrahepatic bile duct dilation (p = 0.022), and homogeneous arterial-phase enhancement on CEUS (p < 0.001). Multivariate analysis identified male gender, advanced age, elevated AFP, CA19-9 levels (27-100 U/mL), and homogeneous enhancement as independent predictors. The predictive model demonstrated an AUC of 0.8713 (95% CI: 0.7981-0.9445), with 82.9% sensitivity and 77.8% specificity.

Conclusion: Conventional ultrasound and CEUS features provide additional diagnostic value for the non-invasive identification of hepatitis-associated ICC, enhancing preoperative risk stratification and therapeutic decision making.