Abstract
The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Patients with chronic liver disease at risk for HCC were evaluated retrospectively. Nodules ≥1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and contrast defects in the Kupffer phase were classified as LR-5. Nodules showing early washout, contrast defects in the Kupffer phase, and/or rim enhancement were classified as LR-M. A total of 104 nodules in 104 patients (median age: 70.0 years; interquartile range: 54.5–78.0 years; 74 men) were evaluated. The 48 (46.2%) LR-5 lesions included 45 HCCs, 2 high-flow hemangiomas, and 1 adrenal rest tumor. The PPV of LR-5 for HCC was 93.8% (95% confidence interval (CI): 82.8–98.7%). The 22 (21.2%) LR-M lesions included 16 non-HCC malignancies and 6 HCCs. The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8–100%). In conclusion, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively.
Highlights
Contrast-Enhanced Ultrasound (CEUS) has been available since the late 1990s as a technique for characterizing liver nodules
Algorithm is only applicable to CEUS examinations performed using pure blood pool contrast agents such as Lumason and Definity, the combined bold pool and Kupffer cell contrast agent Sonazoid is useful for the diagnosis of hepatic nodules, including hepatocellular carcinoma (HCC) [11]
The results of the present study showed that the modified CEUS LI-RADS LR-5 category had a high positive predictive value (PPV) of 93.8% for HCC
Summary
Contrast-Enhanced Ultrasound (CEUS) has been available since the late 1990s as a technique for characterizing liver nodules. The HCC guidelines of the American Association for the Study of Liver Diseases [5] in the United States do not accept CEUS as a diagnostic technique for HCC because of the possibility that HCC may be misdiagnosed as intrahepatic cholangiocarcinoma (ICC) [6]. Considering this matter in greater detail, a number of studies have reported that the onset of washout from ICC is usually earlier (within 1 min) than that from HCC and that the degree of washout. When these characteristics are taken into account, CEUS provides high sensitivity and a high positive predictive value for the diagnosis of HCC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
