Contrast-enhanced ultrasound Liver Imaging Reporting and Data System category M: a systematic review and meta-analysis

Shin, Jaeseung; Lee, Sunyoung; Kim, Yeun-Yoon; Chung, Yong Eun; Choi, Jin Young; Park, Mi‐Suk

doi:10.14366/usg.21011

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…The benefit of these improvement was confirmed in our meta-analysis. Our data aggregation revealed that the proportion of HCC cases in LR-M was 59% according to the ACR algorithm and was similar to the pooled proportion from two meta-analyses, with the proportion of HCC cases in LR-M with SonoVue being 54% ( 30 ) and 57% ( 24 ), which also supports the applicability of the ACR LR-M algorithm for Sonazoid to some extent. However, this proportion was higher in the LR-M modified criteria 1, with HCC accounting for 72.5%, and this proportion reduced to 55.9% in the LR-M modified criteria 2 when the second modification was applied.…”

Section: Discussionsupporting

confidence: 81%

The American College of Radiology contrast-enhanced ultrasound Liver Imaging Reporting and Data System and its modified version in diagnosing hepatocellular carcinoma via Sonazoid: a meta-analysis

Cao,

Wang,

Ruan

et al. 2024

Quant Imaging Med Surg

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Background The American College of Radiology (ACR) developed the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for pure blood contrast agents, but Sonazoid was not included. Modifications to LI-RADS have been proposed for Sonazoid. The purpose of this meta-analysis was to identify and compare the diagnostic efficacy of the two LI-RADS algorithms of Sonazoid. Methods We searched the PubMed, MEDLINE, Web of Science, Embase, and Cochrane Library databases from databases inception to August 31, 2023, to find original studies on the ACR LI-RADS and/or modified LI-RADS algorithm with Sonazoid used as the contrast agent in patients with high-risk hepatocellular carcinoma (HCC). A bivariate random-effects model was used. Data pooling, meta-regression, and sensitivity analysis were performed for meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the methodological quality, and the Deeks funnel plot asymmetry test was used to evaluate the publication bias. Results A meta-analysis of 10 studies with 1,611 observations was conducted. The pooled data for ACR LI-RADS category 5 (LR-5) and modified LR-5 were respectively as follows: pooled sensitivity, 0.70 [95% confidence interval (CI): 0.64–0.75] and 0.81 (95% CI: 0.76–0.86) (P<0.05); pooled specificity, 0.90 (95% CI: 0.82–0.94) and 0.87 (95% CI: 0.81–0.91) (P>0.05); and pooled area under the summary receiver operating characteristic curve, 0.84 and 0.91. The diagnostic performance of LI-RADS category M (LR-M) of the two algorithms was comparable. Study heterogeneity was observed. Conclusions The results indicated that modified LR-5 algorithm demonstrated improved diagnostic sensitivity compared with the ACR LR-5 algorithm of Sonazoid, with differences observed between the different versions. Further research is needed to validate and explore the optimal diagnostic criteria for HCC using Sonazoid. Before the database search was conducted, this study was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42023455220).

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Section: Discussionsupporting

confidence: 81%

The American College of Radiology contrast-enhanced ultrasound Liver Imaging Reporting and Data System and its modified version in diagnosing hepatocellular carcinoma via Sonazoid: a meta-analysis

Cao,

Wang,

Ruan

et al. 2024

Quant Imaging Med Surg

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“…All LR-M from our cohort were confirmed as malignancies, therefore with better accuracy than that of the CT/MRI LR-M (93%) category reported in a previous meta-analysis [ 27 ]. HCCs represented 44.8% of the LR-M group, while the proportion of other malignancies was 55.1%, which was also higher than in other CEUS LI-RADS studies [ 28 , 29 ], but similar to CT/MRI LI-RADS (57–77%) [ 30 ]. This could be associated with geographic differences in the dominant etiologies of underlying liver disease, which is in accordance with studies from Western countries which had a lower proportion of HCCs and a higher proportion of non-HCC malignancies in the CEUS LR-M category than those from Asian countries [ 29 ].…”

Section: Discussionmentioning

confidence: 67%

“…HCCs represented 44.8% of the LR-M group, while the proportion of other malignancies was 55.1%, which was also higher than in other CEUS LI-RADS studies [ 28 , 29 ], but similar to CT/MRI LI-RADS (57–77%) [ 30 ]. This could be associated with geographic differences in the dominant etiologies of underlying liver disease, which is in accordance with studies from Western countries which had a lower proportion of HCCs and a higher proportion of non-HCC malignancies in the CEUS LR-M category than those from Asian countries [ 29 ]. Furthermore, in our cohort, 48.2% of non-HCC malignant nodules had suggestive early washout <60 s. In a recent meta-analysis, the majority of all CEUS LR-M lesions were malignancies (94%), with HCCs representing 54% and non-HCC malignancies representing 40%.…”

Section: Discussionmentioning

confidence: 67%

“…Furthermore, in our cohort, 48.2% of non-HCC malignant nodules had suggestive early washout <60 s. In a recent meta-analysis, the majority of all CEUS LR-M lesions were malignancies (94%), with HCCs representing 54% and non-HCC malignancies representing 40%. The frequencies of individual CEUS LR-M imaging features varied; early washout showed the highest frequency for non-HCC malignancies [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Role of Contrast-Enhanced Ultrasonography in Hepatocellular Carcinoma by Using LI-RADS and Ancillary Features: A Single Tertiary Centre Experience

et al. 2021

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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.

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Contrast-enhanced ultrasound (CEUS) in patients with metastasis-like hepatic alveolar echinococcosis: a cohort study

et al. 2022

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Purpose Hepatic alveolar echinococcosis (HAE) of the metastasis-like pattern, according to the Echinococcus Ulm classification, is usually discovered as an incidental finding, and the diagnostic differentiation from “true metastases” is difficult. The aim of this study was to investigate whether lesions of the “metastasis-like pattern” in HAE show a typical contrast behavior that can be used for differentiation from metastasis in malignancies. Methods This prospective clinical study included 11 patients with histologically confirmed HAE of the metastasis-like pattern (7 female and 4 male; mean age, 57.1 years; mean disease duration, 59.5 months), who had been examined by B-scan sonography and CEUS, from the National Echinococcosis Registry Germany. Results On contrast-enhanced sonography, 11/11 reference lesions showed annular rim enhancement in the arterial and portal venous phases. Throughout the entire 4-min study period, none of the reference lesions showed central contrast enhancement—i.e., all exhibited a complete “black hole sign”. A small central scar was seen in 81.8% of cases. Conclusion In clinically unremarkable patients with incidentally detected metastasis-like lesions of the liver, contrast-enhanced sonographic detection of rim enhancement without central contrast uptake (black hole sign) should be considered evidence supporting a diagnosis of hepatic alveolar echinococcosis with a rare metastasis-like pattern. This can help to differentiate HAE from metastases, especially in high-endemic areas.

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Contrast-enhanced ultrasound Liver Imaging Reporting and Data System category M: a systematic review and meta-analysis

Cited by 4 publications

References 24 publications

The American College of Radiology contrast-enhanced ultrasound Liver Imaging Reporting and Data System and its modified version in diagnosing hepatocellular carcinoma via Sonazoid: a meta-analysis

The American College of Radiology contrast-enhanced ultrasound Liver Imaging Reporting and Data System and its modified version in diagnosing hepatocellular carcinoma via Sonazoid: a meta-analysis

Role of Contrast-Enhanced Ultrasonography in Hepatocellular Carcinoma by Using LI-RADS and Ancillary Features: A Single Tertiary Centre Experience

Contrast-enhanced ultrasound (CEUS) in patients with metastasis-like hepatic alveolar echinococcosis: a cohort study

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