Diagnosis of Non-Hepatocellular Carcinoma Malignancies in Patients With Risks for Hepatocellular Carcinoma: CEUS LI-RADS Versus CT/MRI LI-RADS

Abstract

Objective: Data 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 methods: In 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.

Results: Ninety-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).

Conclusion: CEUS LI-RADS v2017 and CT/MRI LI-RADS v2018 showed similar value for diagnosing non-HCC primary hepatic malignancies in patients with risks.

Keywords: computed tomography; contrast-enhanced ultrasound; liver imaging reporting and data system; magnetic resonance imaging; non-hepatocelluar carcinoma malignancies.

Figure 1

Flowchart of study sample.CEUS, contrast enhanced ultrasound; HCC, hepatocellular carcinoma; LI-RADS, Liver Imaging Reporting and Data System.

Figure 2

Images in a 63-year-old man with chronic hepatitis B virus infection and pathological confirmed intrahepatic cholangiocarcinoma lesion, which was correctly classified as LR-M both on CEUS and gadopentetate-enhanced MRI. T1-weighted image shows a 58-mm nodule in hepatic segment II/III/IV with rim arterial phase hyperenhancement (arrow) in (A) arterial phase followed by delayed central enhancement (arrow) in (B) portal phase. Contrast-enhanced US image shows a 68-mm nodule with rim arterial phase hyper-enhancement (arrow) in (C) arterial phase (timer, 00:22) followed by marked washout (arrow) visible in (D) portal phase (timer, 01:49).

Figure 3

Images in a 54-year-old man with chronic hepatitis B virus infection and pathological confirmed combined hepatocellular cholangiocarcinoma, which was correctly classified as LR-M on CEUS but mistaken as LR-5 on gadopentetate-enhanced MRI. T1-weighted image shows a 53-mm nodule in hepatic segment VI with arterial phase hyperenhancementand (arrow) in (A) arterial phase followed by enhancing capsule (arrow) and non-rim washout in (B) delayed phase. Contrast-enhanced US image shows a 64-mm nodule with heterogeneous hyperenhancement (not rim or peripheral discontinued globular enhancement) (arrow) in (C) arterial phase (timer, 00:19) followed by early washout (arrow) in (D) portal phase (timer, 00:51) and mild washout in delayed phase.