Abstract
Clinical utility of ancillary features (AFs) in contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®) is yet to be established. In this study, we assessed the diagnostic yield of CEUS LI-RADS and AFs in hepatocellular carcinoma (HCC). We retrospectively included patients with risk factors for HCC and newly diagnosed focal liver lesions (FLL). All lesions have been categorized according to the CEUS LI-RADS v2017 by an experienced sonographer blinded to clinical data and to the final diagnosis. From a total of 143 patients with 191 FLL, AFs favoring HCC were observed in 19.8% cases as hypoechoic rim and in 16.7% cases as nodule-in nodule architecture. From the total of 141 HCC cases, 83.6% were correctly classified: 57.4%- LR-5 and 26.2%- LR-4. In 9.21% cases, CEUS indicated LR-M; 2.12% cases- LR-3. The LR-5 category was 96.2% predictive (PPV) of HCC. LR-5 had 60.4% sensitivity and 93.6% specificity. PPV for primitive malignancy (LR-4 + LR-5) was 95.7%, with 88% sensitivity, 89.3% specificity and 88.4% accuracy for HCC. LR-4 category had 94.8% PPV and 26.2% sensitivity. CEUS LR4 + LR5 had 81,8% sensitivity for HCCs over 2 cm and 78.57% sensitivity for smaller HCCs. CEUS LR-5 remains an excellent diagnostic tool for HCC, despite the size of the lesion. The use of AFs might improve the overarching goal of LR-5 + LR-4 diagnosis of high specificity for HCC and exclusion of non-HCC malignancy.
Highlights
Accurate differential diagnostic is mandatory with other malignant lesions such as intrahepatic cholangiocellular carcinoma (ICC), which is the second most common primary malignant liver tumor that usually arises in healthy liver parenchyma, with different treatment approaches and prognosis [3]
The aim of this study was to assess the diagnostic yield of this imaging method recently introduced by using the newest LI-RADS algorithm and ancillary features, originally developed for computed tomography (CT) and magnetic resonance imaging (MRI), in the characterization and diagnosis of focal liver lesions (FLL) and of Hepatocellular carcinoma (HCC)
The differential diagnosis between HCC, cholangiocarcinoma and liver metastases may be limited by similarities in the appearance of contrast-enhanced ultrasound (CEUS)
Summary
Liver tumors are a heterogeneous pathology with multiple variables, which are not uniform globally, making it difficult to establish a system of accurate diagnosis and prognosis. HCC develops almost exclusively in the context of a chronic liver pathology and in about 90% of cases the patient has liver cirrhosis, the occurrence of which is determined by various etiologies. Chronic infections with hepatitis B and C viruses are recognized worldwide as the main factors involved in hepatocarcinogenesis, with the risk of developing HCC in infected patients being up to 30 times higher [2]. Accurate differential diagnostic is mandatory with other malignant lesions such as intrahepatic cholangiocellular carcinoma (ICC), which is the second most common primary malignant liver tumor that usually arises in healthy liver parenchyma, with different treatment approaches and prognosis [3]
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