Noninvasive Diagnosis of Hepatocellular Carcinoma on Sonazoid-Enhanced US: Value of the Kupffer Phase.

Hiroshi Takahashi,Naohisa Kamiyama,Takao Itoi,Yu Yoshimasu,Tatsuya Kakegawa,Katsutoshi Sugimoto,Takuya Wada,Yusuke Tomita,Masakazu Abe,Hirohito Takeuchi,Kentaro Sakamaki

doi:10.3390/diagnostics12010141

Hiroshi Takahashi, Naohisa Kamiyama + Show 9 more

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https://doi.org/10.3390/diagnostics12010141

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Abstract

The aim of this study was to compare the diagnostic performance of Contrast-Enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) version 2017, which includes portal- and late-phase washout as a major imaging feature, with that of modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature. Participants at risk of hepatocellular carcinoma (HCC) with treatment-naïve hepatic lesions (≥1 cm) were recruited and underwent Sonazoid-enhanced US. Arterial phase hyperenhancement (APHE), washout time, and echogenicity in the Kupffer phase were evaluated using both criteria. The diagnostic performance of both criteria was analyzed using the McNemar test. The evaluation was performed on 102 participants with 102 lesions (HCCs (n = 52), non-HCC malignancies (n = 36), and benign (n = 14)). Among 52 HCCs, non-rim APHE was observed in 92.3% (48 of 52). By 5 min, 73.1% (38 of 52) of HCCs showed mild washout, while by 10 min or in the Kupffer phase, 90.4% (47 of 52) of HCCs showed hypoenhancement. The sensitivity (67.3%; 35 of 52; 95% CI: 52.9%, 79.7%) of modified CEUS LI-RADS criteria was higher than that of CEUS LI-RADS criteria (51.9%; 27 of 52; 95% CI: 37.6%, 66.0%) (p = 0.0047). In conclusion, non-rim APHE with hypoenhancement in the Kupffer phase on Sonazoid-enhanced US is a feasible criterion for diagnosing HCC.

Highlights

Hepatocellular carcinoma (HCC) is the only type of cancer diagnosed noninvasively in high-risk patients on the basis of typical imaging features of CT, MRI, or contrast-enhanced ultrasound (CEUS) [1,2]
The current version of CEUS LI-RADS is applicable only to the pure blood pool contrast agents but not to the combined blood pool and Kupffer cell agents. This is because pure blood pool agents provide effective arterial phase hyperenhancement (APHE) and ensure pure contrast agent washout from malignant nodules
The purpose of our study was to compare the diagnostic performance of Sonazoid-enhanced US in the noninvasive diagnosis of HCC based on the CEUS LI-RADS (2017 version) and that based on the modified CEUS LI-RADS (i.e., Kupffer-phase findings are used as an alternative to “washout”)

Summary

Introduction

Hepatocellular carcinoma (HCC) is the only type of cancer diagnosed noninvasively in high-risk patients on the basis of typical imaging features of CT, MRI, or contrast-enhanced ultrasound (CEUS) [1,2]. To improve the diagnostic accuracy for HCC and to facilitate communication among radiologists and between radiologists and other physicians, the American College of Radiology developed the Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) as a standardized reporting system for liver nodules in patients at risk for HCC [4]. The current version of CEUS LI-RADS (version 2017) is applicable only to the pure blood pool contrast agents but not to the combined blood pool and Kupffer cell agents. This is because pure blood pool agents provide effective arterial phase hyperenhancement (APHE) and ensure pure contrast agent washout from malignant nodules

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