Diagnostic performance of intravascular perfusion based contrast-enhanced ultrasound LI-RADS in the evaluation of hepatocellular carcinoma

Abstract

BACKGROUND: The contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) is a relative new algorithm for hepatocellular carcinoma (HCC) assessment. OBJECTIVE: To validate the diagnostic efficiency of the intravascular perfusion based CEUS LI-RADS for HCC. METHODS: Archives of 873 patients with focal liver lesions (FLLs) undergoing CEUS were reviewed, and target images were read by two sonologists independently according to the CEUS LI-RADS. The diagnostic performance was calculated and compared. RESULTS: Assessment with reference to CEUS LI-RADS, 87 of 218 FLLs (39.9%) were categorized as LR-5, 131 of 218 FLLs (60.1%) were categorized as non-LR-5, 19 of 99 HCCs were categorized as non-LR-5, and 7 of 119 non-HCCs were categorized as LR-5. The sensitivity, specificity, AUROC, positive and negative predictive values of CEUS LI-RADS for diagnosing HCC were 80.81%(95%CI: 71.7%–88.0%), 94.1%(95%CI: 88.3%–97.6%), 0.87 (95%CI: 0.82–0.92), 91.9%(95%CI: 84.1%–96.7%), and 85.5%(95%CI: 78.3%–91.0%), respectively. CONCLUSIONS: The diagnostic efficiency of the intravascular perfusion based CEUS LI-RADS for the evaluation of HCCs is very good.

LI-RADS LR-5 on contrast-enhanced ultrasonography has satisfactory diagnostic specificity for hepatocellular carcinoma: a systematic review and meta-analysis

“…From another perspective, the specific physical, chemical, and biological features of contrast agents can result in potentially different patterns in imaging signs. The contrast agents used for CEUS manifest as intravascular microbubbles, which show clearer and more typical enhancement patterns of HCC and intrahepatic cholangiocarcinoma, and thus, may contribute to higher diagnostic accuracy and specificity ( 36 , 37 ). Moreover, since CEUS and CT/MRI rely on different diagnostic parameters due to distinct image acquisition techniques and the properties of contrast agents, a couple of studies have suggested that CEUS should be supplemented if results of more than 2 imaging techniques contradicted ( 38 ).…”

Compared with SonoVue® LR-5, Sonazoid® modified LR-5 has better diagnostic sensitivity for hepatocellular carcinoma: a systematic review and meta-analysis

“…Three studies were prospective ( 13 , 19 , 38 ) and 23 were retrospective ( 14 - 18 , 20 - 37 ). Of the studies, 10 used histopathology only as the reference standard ( 15 , 16 , 19 , 21 , 23 - 25 , 27 , 30 , 33 ) and 16 used both histopathology and imaging follow-up as the reference standard ( 13 , 14 , 17 , 18 , 20 , 22 , 26 , 28 , 29 , 31 , 32 , 34 - 38 ).…”

“…The results of the index test and reference standard domain were satisfactory. In relation to the patient selection domain, two studies had a high risk of selection bias due to their case-control study designs ( 15 , 21 ), and seven studies had a unclear risk, as the inclusion criteria for the nodule size was not specified ( 13 , 22 , 25 , 27 , 32 , 33 , 39 ). In relation to the flow and timing domain, the quality of the included studies was relatively low, which might be due to the use of mixed reference standards (pathology and imaging diagnosis or pathology only) and unclear the time interval between the index test(s) and reference standards.…”

Current aspects of multimodal ultrasound liver diagnostics using contrast-enhanced ultrasonography (CEUS), fat evaluation, fibrosis assessment, and perfusion analysis – An update

“…At least preliminary studies indicate an improved characterization of differently pronounced peri-tumoral microvascularization with high-resolution contrast imaging in CEUS supplemented by parametric false-color imaging [ 2 ]. According to the Liver Imaging Reporting and Data System (LI-RADS) classification, the detection of small tumor foci in only arterial hypercontrast up to 10 mm, a reliable differentiation of adenomas or regressively altered tumors, and the detection of all tumor foci in poor acoustic conditions may require complementary imaging with CT and or MERT with liver-specific contrast agent as an alternative to histologic confirmation [ 26 ].…”