Abstract
ObjectiveTo explore whether risk stratification based on ultrasound elastography of liver background assists contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) in diagnosing HCC.Materials and MethodsIn total, 304 patients with focal liver lesions (FLLs) confirmed by pathology underwent CEUS and ultrasound elastography were included in this retrospective study. Patients with chronic hepatitis B (CHB, n=193) and non-CHB (n=111) were stratified by four liver stiffness measurement (LSM) thresholds. A LI-RADS category was assigned to FLLs using CEUS LI-RADS v2017. The diagnostic performance was assessed with the AUC, sensitivity, specificity, PPV, and NPV.ResultsThe mean background liver stiffness of HCC patients with CHB, HCC patients without CHB and non-HCC patients without CHB were 9.72 kPa, 8.23 kPa and 4.97 kPa, respectively. The AUC, sensitivity, specificity and PPV of CEUS LI-RADS for HCC in CHB patients with LSM ≥ 5.8 kPa, ≥ 6.8 kPa, ≥ 9.1 kPa, and ≥ 10.3 kPa were high, with corresponding values of 0.745 to 0.880, 94.2% to 95.3%, 81.3% to 85.7%, and 98.1% to 98.8%, respectively. Higher AUC and specificity for HCC was observed in non-CHB patients with LSM ≥ 9.1 kPa and ≥ 10.3 kPa compared to non-CHB patients with LSM ≥ 5.8 kPa and ≥ 6.8 kPa, with corresponding values of0.964/1.000 vs 0.590/0.580, and 100%/100% vs 60%/70%, respectively.ConclusionCEUS LI-RADS has a good diagnostic performance in CHB patients regardless of the background liver stiffness. Furthermore, CEUS LI-RADS can be applied for non-CHB patients with a LSM ≥ 9.1 kPa.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor in the world and the third leading cause of cancer death [1, 2]
This study explored whether risk stratification based on ultrasound elastography of the liver background of chronic hepatitis B patients (CHB) and non-CHB patients assists CEUS LI-RADS in diagnosing HCC
The results showed that the diagnostic performance of CEUS LIRADS was good in CHB patients with different degrees of liver stiffness, which indicated that CHB patients, even without high liver stiffness values, are still at risk for HCC
Summary
Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor in the world and the third leading cause of cancer death [1, 2]. LI-RADS was mainly developed for populations with high-risk factors for HCC, and several studies have reported that this system has good diagnostic accuracy [9,10,11,12,13,14,15]. The latest guidelines and recommendations for contrast-enhanced ultrasound of the liver published by the World Federation for Ultrasound in Medicine and Biology (WFUMB) indicate that CEUS LI-RADS can be utilized to establish a diagnosis of malignancy (CEUS LR-M) or, HCC (CEUS LR-5), in high-risk patients [16]. Identifying high-risk patients only by conventional imaging can sometimes be difficult for radiologists because radiologists do not always receive complete clinical information about patients to determine whether they have risk factors for HCC, especially first-time outpatients and patients in developing countries. As ultrasound is a first-line screening and diagnostic method for liver cancer, the following question arises: is there any way to help ultrasound physicians determine whether a patient is at risk for HCC?
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