Abstract

ObjectiveData regarding direct comparison of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) and Computed Tomography/Magnetic Resonance Imaging (CT/MR) LI-RADS in diagnosis of non-hepatocelluar carcinoma (non-HCC) malignancies remain limited. Our study aimed to compare the diagnostic performance of the CEUS LI-RADS version 2017 and CT/MRI LI-RADS v2018 for diagnosing non-HCC malignancies in patients with risks for HCC.Materials and MethodsIn this retrospective study, 94 liver nodules pathologically-confirmed as non-HCC malignancies in 92 patients at risks for HCC from January 2009 to December 2018 were enrolled. The imaging features and the LI-RADS categories on corresponding CEUS and CT/MRI within 1 month were retrospectively analyzed according to the ACR CEUS LI-RADS v2017 and ACR CT/MRI LI-RADS v2018 by two radiologists in consensus for each algorithm. The sensitivity of LR-M category, inter-reader agreement and inter-modality agreement was compared between these two standardized algorithms.ResultsNinety-four nodules in 92 patients (mean age, 54 years ± 10 [standard deviation] with 65 men [54 years ± 11] and 27 women [54 years ± 8]), including 56 intrahepatic cholangiocarcinomas, 34 combined hepatocellular cholangiocarcinomas, two adenosquamous carcinomas of the liver, one primary hepatic neuroendocrine carcinoma and one hepatic undifferentiated sarcoma were included. On CEUS, numbers of lesions classified as LR-3, LR-4, LR-5 and LR-M were 0, 1, 10 and 83, and on CT/MRI, the corresponding numbers were 3, 0, 14 and 77. There was no significant difference in the sensitivity of LR-M between these two standardized algorithms (88.3% of CEUS vs 81.9% of CT/MRI, p = 0.210). Seventy-seven lesions (81.9%) were classified as the same LI-RADS categories by both standardized algorithms (five for LR-5 and 72 for LR-M, kappa value = 0.307). In the subgroup analysis for ICC and CHC, no significant differences were found in the sensitivity of LR-M category between these two standardized algorithms (for ICC, 94.6% of CEUS vs 89.3% of CT/MRI, p = 0.375; for CHC, 76.5% of CEUS vs 70.6% of CT/MRI, p = 0. 649).ConclusionCEUS LI-RADS v2017 and CT/MRI LI-RADS v2018 showed similar value for diagnosing non-HCC primary hepatic malignancies in patients with risks.

Highlights

  • Primary hepatic malignancies consist of HCC (75–85%) (1) and non-HCC malignancy, which includes intrahepatic cholangiocarcinoma (ICC, 10–15%) (1), combined hepatocellular cholangiocarcinoma (CHC,

  • Ninety-four non-HCC primary hepatic malignancies confirmed by pathology in 92 patients with risks were enrolled in the final analysis, including 56 (60%) intrahepatic cholangiocarcinomas, 34 (36%) combined hepatocellular cholangiocarcinomas, two (2%) adenosquamous carcinomas of the liver, one (2%) primary hepatic neuroendocrine carcinoma and one (1%) hepatic undifferentiated sarcoma

  • High specificity of LR-5 for HCC and high sensitivity of LR-M for non-HCC malignancies are required to meet the purpose of LI-RADS on achieving accurate diagnosis, which helps to choose the proper treatments

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Summary

Introduction

Primary hepatic malignancies consist of HCC (75–85%) (1) and non-HCC malignancy, which includes intrahepatic cholangiocarcinoma (ICC, 10–15%) (1), combined hepatocellular cholangiocarcinoma (CHC,

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