Comparison of modified CEUS LI‐RADS with sonazoid and CT/MRI LI‐RADS for diagnosis of hepatocellular carcinoma

Sugimoto, Katsutoshi; Saito, Kazuhiro; Shirota, Natsuhiko; Kamiyama, Naohisa; Sakamaki, Kentaro; Takahashi, Hiroshi; Wada, Takuya; Kakegawa, Tatsuya; Tomita, Yusuke; Abé, Masakazu; Yoshimasu, Yu; Takeuchi, Hirohito; Itoi, Takao

doi:10.1111/hepr.13793

Cited by 11 publications

(13 citation statements)

References 23 publications

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“…CEUS is a US examination widely accepted in many clinical contexts, performed by injecting intravenously microbubble-based contrast agents (USCAs). USCAs are small (from 1 to 10 μm) biodegradable particles of low-solubility gases (e.g., perfluoropropane, perfluorocarbon or sulfur hexafluoride) covered by a flexible lipid shell [ 212 , 213 , 214 , 215 , 216 , 217 ]. This type of contrast agent is confined within the intravascular space (blood pool agents) and almost completely exhaled after 20 min from the injection.…”

Section: Li-radsmentioning

confidence: 99%

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

et al. 2022

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Liver cancer is the sixth most detected tumor and the third leading cause of tumor death worldwide. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with specific risk factors and a targeted population. Imaging plays a major role in the management of HCC from screening to post-therapy follow-up. In order to optimize the diagnostic-therapeutic management and using a universal report, which allows more effective communication among the multidisciplinary team, several classification systems have been proposed over time, and LI-RADS is the most utilized. Currently, LI-RADS comprises four algorithms addressing screening and surveillance, diagnosis on computed tomography (CT)/magnetic resonance imaging (MRI), diagnosis on contrast-enhanced ultrasound (CEUS) and treatment response on CT/MRI. The algorithm allows guiding the radiologist through a stepwise process of assigning a category to a liver observation, recognizing both major and ancillary features. This process allows for characterizing liver lesions and assessing treatment. In this review, we highlighted both major and ancillary features that could define HCC. The distinctive dynamic vascular pattern of arterial hyperenhancement followed by washout in the portal-venous phase is the key hallmark of HCC, with a specificity value close to 100%. However, the sensitivity value of these combined criteria is inadequate. Recent evidence has proven that liver-specific contrast could be an important tool not only in increasing sensitivity but also in diagnosis as a major criterion. Although LI-RADS emerges as an essential instrument to support the management of liver tumors, still many improvements are needed to overcome the current limitations. In particular, features that may clearly distinguish HCC from cholangiocarcinoma (CCA) and combined HCC-CCA lesions and the assessment after locoregional radiation-based therapy are still fields of research.

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Section: Li-radsmentioning

confidence: 99%

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

et al. 2022

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“…The arterial phase hyperenhancement of LR‐3 and LR‐4 nodules are more efficiently detected on CEUS than CT/MRI. In contrast, the LR‐M nodules are better evaluated by CT/MRI than CEUS 4 …”

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confidence: 97%

“…Moreover, a multi-center study in collaboration with US institutions is needed. 3,4 Based on the results, the modified CEUS LI-RADS LR-5 category was the optimal diagnostic tool for histopathologically proven HCC. Additionally, the modified CEUS LI-RADS LR-M category was the optimal diagnostic tool for histopathologically proven non-HCC malignancies (including intrahepatic cholangiocarcinoma and metastases) with a high positive predictive value (PPV).…”

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confidence: 99%

“…Sugimoto K, et al. reported the modified CEUS LI‐RADS, an algorithm that included Sonazoid with minimal modifications to the existing CEUS LI‐RADS algorithm 3,4 . Based on the results, the modified CEUS LI‐RADS LR‐5 category was the optimal diagnostic tool for histopathologically proven HCC.…”

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confidence: 99%

“…In contrast, the LR-M nodules are better evaluated by CT/MRI than CEUS. 4 CEUS LI-RADS with perfluorobutane microbubbles can correctly diagnose nodules that will otherwise be misdiagnosed by CT/MRI LI-RADS, and there is great potential to improve the diagnostic performance of HCC by performing both CEUS with perfluorobutane microbubbles and CT/MRI LI-RADS. Thus, there is hope for CEUS LI-RADS with perfluorobutane microbubbles.…”

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confidence: 99%

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Liver imaging reporting and data with perfluorobutane microbubbles—Is there hope?

Hirooka

2022

Hepatology Research

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Liver imaging reporting and data with perfluorobutane microbubbles-Is there hope?The Reporting and Data System (RADS) was proposed as an imaging standardization project led by the American College of Radiology. The RADS was established to standardize the reporting of imaging findings and the terminology, thereby making it more understandable for nonspecialists. Reporting systems for images of the liver, breast, lungs, thyroid, and prostate have been established. These are accessible via the website (https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems). Translated into several languages, the Liver Imaging RADS (LI-RADS) has been proposed as the standard reporting system in patients diagnosed via computed tomography (CT)/magnetic resonance imaging (MRI), ultrasound (US), and contrast-enhanced US (CEUS). In 2018, the LI-RADS classification was adopted as a hepatocellular carcinoma (HCC) surveillance method by the American Association for the Study of Liver Diseases (AASLD). 1There are two concerns regarding the CEUS LI-RADS. First, CEUS LI-RADS has not been integrated into the diagnostic criteria of the AASLD practice guideline. However, a meta-analysis, supporting the viability of CEUS as a diagnostic tool for HCC, was reviewed. 2

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Comparison of the Feasibility and Diagnostic Performance of ACR CEUS LI‐RADS and a Modified CEUS LI‐RADS for HCC in Examinations Using Sonazoid

Liao

Que

Wen

et al. 2023

J of Ultrasound Medicine

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ObjectivesThe present study aimed to determine the feasibility of the American College of Radiology's (ACR) contrast‐enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI‐RADS) (version 2017) in examinations using Sonazoid and compare its diagnostic performance with that of modified LI‐RADS in patients at high risk of hepatocellular carcinoma (HCC).MethodsThis retrospective study's sample population consisted of 137 participants with a total of 140 nodules who underwent CEUS with Sonazoid and pathological confirmation via surgery or biopsy from January 2020 to February 2022. The lesions were evaluated and classified based on the reference standards (ie, ACR CEUS LI‐RADS and modified LI‐RADS). The overall diagnostic capabilities of the two systems were evaluated in terms of accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals (CIs).ResultsThe participants had a median age of 51 years and an interquartile range of 43–58 years. Regarding LR‐5 as a predictor of HCC, the accuracy results of the ACR LI‐RADS and modified LI‐RADS algorithms were 72.9 and 71.4%, respectively (P = .50). The sensitivity of both systems was the same (69.7%; 95% CI: 60.7–77.8%). Regarding LR‐M as a predictor of non‐HCC malignancy, the diagnostic performance of the algorithms was the same, with accuracy and sensitivity results of 76.4 and 73.3%, respectively (95% CI: 44.9–92.2%).ConclusionThe findings indicate that modified LI‐RADS had a moderate level of diagnostic performance for HCC in examinations using Sonazoid, which was comparable to ACR LI‐RADS.

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Comparison of modified CEUS LI‐RADS with sonazoid and CT/MRI LI‐RADS for diagnosis of hepatocellular carcinoma

Cited by 11 publications

References 23 publications

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

Liver imaging reporting and data with perfluorobutane microbubbles—Is there hope?

Comparison of the Feasibility and Diagnostic Performance of ACR CEUS LI‐RADS and a Modified CEUS LI‐RADS for HCC in Examinations Using Sonazoid

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