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

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.