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. 2023 Sep 11;23(1):122.
doi: 10.1186/s12880-023-01088-1.

Differences between CEUS LI-RADS and CECT LI-RADS in the diagnosis of focal liver lesions in patients at risk for HCC

Rong Wen #  1 , Weiche Huang #  1 , Rui Song  2 , Lanhui Qin  2 , Yuquan Wu  1 , Yuting Peng  3 , Xiongyan Huang  4 , Yun He  1 , Hong Yang  5
Affiliations

Differences between CEUS LI-RADS and CECT LI-RADS in the diagnosis of focal liver lesions in patients at risk for HCC

Rong Wen et al. BMC Med Imaging. .

Abstract

Objectives: To compare the inter-modality consistency and diagnostic performances of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) and contrast-enhanced computed tomography (CECT) LI-RADS in patients at risk for hepatocellular carcinoma (HCC), so as to help clinicians to select a more appropriate modality to follow the focal liver lesions (FLLs).

Methods: This retrospective study included untreated 277 FLLs from 247 patients who underwent both CEUS and CECT within 1 month. The ultrasound contrast medium used was SonoVue. FLL categories were independently assigned by two ultrasound physicians and two radiologists using CEUS LI-RADS v2017 and CECT LI-RADS v2018, respectively. The diagnostic performances of CEUS and CECT LI-RADS were evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Cohen's Kappa was employed to evaluate the concordance of the LI-RADS category.

Results: The inter-modality consistency for CEUS and CECT LI-RADS was 0.31 (p < 0.001). HCC was more frequently observed in CECT LR-3 and LR-4 hepatic lesions than in CEUS (7.3% vs. 19.5%, p < 0.001). The specificity and PPV of CEUS and CECT LR-5 for the diagnosis of HCC were 89.5%, 95.0%, and 82.5%, 94.4%, respectively. The sensitivity of CEUS LR-5 + LR-M for the diagnosis of hepatic malignancies was higher than that of CECT (93.7% vs. 82.7%, p < 0.001). The specificity and PPV of CEUS LR-M for the diagnosis of non-HCC malignancies were lower than those of CECT (59.7% vs. 95.5%, p < 0.001; 23.4% vs. 70.3%, p < 0.001).

Conclusions: The inter-modality consistency between the CEUS and CECT LI-RADS categories is fair. CEUS LI-RADS was more sensitive than CECT LI-RADS in terms of identifying hepatic malignancies, but weaker in terms of separating HCC from non-HCC malignancies.

Keywords: Computed tomography; Hepatocellular carcinoma; Liver Imaging Reporting and Data System; Ultrasonography.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
LI-RADS rating criteria. (a) and (b) show the diagnostic tables of CEUS and CECT, respectively. LI-RADS = Liver Imaging Reporting and Data System; CEUS = contrast-enhanced ultrasound; CECT = contrast-enhanced computed tomography
Fig. 2
Fig. 2
A lesion in segment 4 of the liver that was classified as LR-5 via CEUS and LR-4 via CECT, and eventually pathologically confirmed as HCC in a man with chronic hepatitis B. (a) Conventional ultrasound showed a hypoechoic mass measuring 2.6 × 1.8 cm in segment 4 of the liver. (b) CEUS displayed hyperenhancement in the arterial phase and mild washout in the portal (c) and late (d) phases. (e) Nonenhanced CT displayed a hypodense mass measuring 2.6 × 1.6 cm in segment 4 of the liver. (f) CECT showed isoenhancement in the arterial phase and washout in the portal (g) and late (h) phases
Fig. 3
Fig. 3
A lesion in segment 5 of the liver that was classified as LR-M via CEUS, LR-5 via CECT, and eventually pathologically confirmed as HCC in a man with hepatitis B-related cirrhosis. (a) Conventional ultrasound showed a hypoechoic mass measuring 3.2 × 2.1 cm in segment 5 of the liver. (b) CEUS displayed hyperenhancement in the arterial phase. (c) CEUS displayed early washout (42 s after injection) in the portal phase and (d) mild washout in the late phase. (e) Nonenhanced CT showed a hypodense mass measuring 2.9 × 2.8 cm in segment 5 of the liver. (f) CECT showed hyperenhancement in the arterial and portal (g) phases and washout in the late (h) phase with a visible enhancing capsule
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