LI-RADS-CEUS – Proposal for a Contrast-Enhanced Ultrasound Algorithm for the Diagnosis of Hepatocellular Carcinoma in High-Risk Populations

Abstract

To develop a contrast-enhanced ultrasound algorithm (LI-RADS-CEUS = liver imaging reporting and data system with contrast-enhanced ultrasound) for the diagnosis of hepatocellular carcinoma (HCC) in patients at risk. A CEUS algorithm (LI-RADS-CEUS) was designed analogously to CT- and MRI-based LI-RADS. LI-RADS-CEUS was evaluated retrospectively in 50 patients at risk with confirmed HCC or non-HCC lesions (test group) with subsequent validation in a prospective cohort of 50 patients (validation group). Results were compared to histology, CE-CT and CE-MRI as reference standards. Tumor diagnosis in the test group/validation group (n = 50/50) were 46/41 HCCs, 3/3 intrahepatic cholangiocellular carcinomas (ICCs) and 1/6 benign lesions. The diagnostic accuracy of LI-RADS-CEUS for HCC, ICC and non-HCC-non-ICC-lesions was 89 %. For the diagnosis of HCC, the diagnostic accuracy was 93.5 % (43/46 cases) in the test group and 95.1 % (39/41 cases) in the validation group. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 %, 66.6 %, 94.3 % and 66.6 %, respectively (mean values from both cohorts). Histological findings of HCC were available in 40 versus 23 cases (in total: G1 / G2/G3: 15/35/13). Arterial hyperenhancement was seen in 68/87 (78.2 %) of HCCs. Arterial hyperenhancement with subsequent portal venous or late phase hypoenhancement was seen in 66 % of HCCs. LI-RADS-CEUS offers a CEUS algorithm for standardized assessment and reporting of focal liver lesions in patients at risk for HCC. Arterial hyperenhancement in CEUS is the key feature for the diagnosis of HCC in patients at risk, whereas washout is not a necessary prerequisite.

Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center

“…Furthermore, CEUS is recommended for the diagnostic workup of patients with colorectal cancer [32]. Similar to the reporting standards of MRI and CT, a reporting algorithm for CEUS has been established, LI-RADS CEUS, which ought to be used for standardized reporting in liver lesions for patients at risk of HCC [33]. So far, only a few studies have evaluated CEUS as a first-line diagnostic tool in the characterization of FLLs compared to MRI.…”

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

“…[1][2][3][4] Doppler and contrast-enhanced ultrasound help in the characterisation of FLL. [5][6][7][8][9] Nonetheless, a proportion of up to 30%-40% remain undetermined, so requiring cross-sectional imaging assessment and/or biopsy. Therefore, simple methods allowing to refine FLL characterisation in real-time on US are needed.…”

Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions

“…Different perfusion patterns have been reported for ICC. For the arterial phase, four perfusion patterns were seen in the literature, including peripheral rim-like hyper-enhancement (50%), heterogeneous hyper-enhancement (24%), heterogeneous hypo-enhancement (20%), and homogeneous hyper-enhancement (6%) (5,6,8). These differences in arterial phase enhancement may be due to the amount of tumor cells and the fiber distribution within the lesions (6).…”

“…Real-time CEUS has been widely used in the diagnosis of hepatic space-occupying lesions (7,8). It has been reported that ICCs showed different perfusion characters during CEUS (4,9-11).…”