Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Diagnosing Hepatocellular Carcinoma: Diagnostic Performance and Interobserver Agreement

Abstract

<jats:title>Abstract</jats:title><jats:p> Objectives To determine the diagnostic performance and inter-reader agreement of the contrast-enhanced ultrasound liver imaging reporting and data system (CEUS-LI-RADS) for diagnosing hepatocellular carcinoma (HCC) in high-risk patients.</jats:p><jats:p> Methods In this prospective study, CEUS-LI-RADS categories (LR-5 for predicting HCC) were assigned by six blinded readers and compared to the definitive HCC diagnosis in patients with liver cirrhosis per the 2017 China Liver Cancer Guidelines (CLCG). CEUS features were recorded in 96 patients with 96 histology-proven lesions. The diagnostic performance of LR-5 was described by the sensitivity, specificity and accuracy. Multi-reader agreement was assessed by using intraclass correlation coefficients (ICC).</jats:p><jats:p> Results In cirrhotic patients, the specificity of LR-5 (range: 92.7–100.0 %) was statistically higher than that of CLCG for each reader (range: 28.6–64.3 %). However, the sensitivity (range: 38.6–63.6 %) and accuracy (range: 53.4–70.7 %) were statistically lower in CEUS-LIRADS than in CLCG (sensitivity range: 88.6–100.0 %; accuracy range: 77.6–86.2 %). Only fair to moderate inter-reader agreement was achieved for the CEUS-LI-RADS category (ICC = 0.595) and washout appearance (ICC range: 0.338 to 0.555). Neither nodule-in-nodule nor mosaic architecture was observed more often in HCC (all P &gt; 0.05), with poor inter-reader consistency for both (both ICC &lt; 0.20).</jats:p><jats:p> Conclusion CEUS-LI-RADS category 5 has a high specificity but a low accuracy for identifying HCC in high-risk patients. Inter-reader agreement is not satisfactory concerning CEUS-LIRADS category and washout appearance. Moreover, the clinical value of ancillary features favoring HCC is quite limited.</jats:p>

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

“…Fifteen articles were excluded after full-text review (Supplementary Table 2). The remaining 10 eligible articles [11][12][13][14][15][16][17][18][19][20] and two annual meeting abstracts [21,22] reported the probabilities of HCCs and non-HCC malignancies in the CEUS LR-M category (Fig. 1).…”

“…1). Among these, seven articles [12,[14][15][16][17]19,20] also reported the frequencies of individual CEUS LR-M imaging features (i.e., rim APHE, early washout, and marked washout). The characteristics of the included studies are summarized in Table 1.…”

“…cohort studies [11][12][13][15][16][17][18][19][20][21][22]. For subject enrollment, eight studies [11,12,15,[18][19][20][21][22] consecutively enrolled subjects, while the other four studies [13,14,16,17] selectively included subjects.…”

“…cohort studies [11][12][13][15][16][17][18][19][20][21][22]. For subject enrollment, eight studies [11,12,15,[18][19][20][21][22] consecutively enrolled subjects, while the other four studies [13,14,16,17] selectively included subjects. Eight studies [13][14][15][16][17][18]20,22] reported hepatitis B virus infection as dominant etiology, while four studies [11,12,19,21] reported other dominant etiologies such as hepatitis C virus infection or alcohol abuse.…”

“…Regarding reference standard, five studies [13][14][15]20,22] used only pathological diagnosis while seven studies [11,12,[16][17][18][19]21] used a combination of pathological diagnosis and composite imaging or clinical follow-up.…”