LI-RADS-CEUS – proposal for a contrast-enhanced ultrasound algorithm for the diagnosis of hepatocellular carcinoma in high-risk populations

Schellhaas, Barbara; Wildner, D; Pfeifer, Lukas; Görtz, RS; Hagel, A; Neurath, MF; Strobel, D

doi:10.1055/s-0036-1587712

Cited by 27 publications

(16 citation statements)

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“…Focal liver lesions (FLL) are a common finding on ultrasound (US) examination, and the discrimination between benign and malignant nature can be extremely challenging in patients with chronic liver disease and subjects with history of malignancy, and sometimes in individuals previously considered healthy . Doppler and contrast‐enhanced ultrasound help in the characterisation of FLL . Nonetheless, a proportion of up to 30%‐40% remain undetermined, so requiring cross‐sectional imaging assessment and/or biopsy.…”

Section: Introductionmentioning

confidence: 99%

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

Grgurević

Bokun

Salkić

et al. 2017

Liver International

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Section: Introductionmentioning

confidence: 99%

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

Grgurević

Bokun

Salkić

et al. 2017

Liver International

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“…The aim of the study was to assess the diagnostic accuracy of standardized CEUS for the non-invasive diagnosis of HCC in cirrhotic patients in a prospective, multicenter real-life approach. The study was designed to compare the diagnostic accuracy based on subjective interpretation by an experienced examiner, the definition according to current guidelines ("arterial phase hyperenhancement followed by hypoenhancement"), and the recently developed CEUS algorithms ESCULAP and CEUS LI-RADS® [7][8][9][10][11][12].…”

Section: Purposementioning

confidence: 99%

“…The standardized algorithms are designed to categorize FLLs in high-risk patients according to defined criteria (such as lesion size and contrast enhancement behavior), resulting in a category that describes the risk of a given lesion being a HCC. With ESCULAP, there are six categories: ESCULAP-1 = definitely benign; ESCULAP-2 = intermediate probability of HCC, uncertain findings; ESCULAP-3 = definite HCC; ESCULAP-C = iCCA; ESCULAP-V = HCC with tumor invasion of the hepatic veins or portal vein; and ESCULAP-X = non-categorizable [7][8][9][10][11]. With CEUS LI-RADS®, there are eight categories: CEUS-LR-1 = definitely benign; CEUS-LR-2 = probably benign; CEUS-LR-3 = intermediate probability of malignancy; CEUS-LR-4 = probably HCC; CEUS-LR-5 = definitely HCC; CEUS-LR-M = probably or definitely malignant, not necessarily HCC; CEUS-LR-TIV = tumor in vein; CEUS-LR-NC = non-categorizable [7].…”

Section: Ceus Algorithmsmentioning

confidence: 99%

“…The LI-RADS® system (Liver Imaging Reporting and Data System) developed by the American College of Radiology (ACR) in order to improve the reporting and documentation of FLLs in high-risk patients has been widely used for several years [6,7]. More recently, standardized algorithms have also been developed for CEUS, such as ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) and CEUS LI-RADS® [7][8][9][10][11][12]. Although there is limited data on this topic so far, initial studies suggest high diagnostic accuracies for all of these algorithms, with positive predictive values (PPVs) of > 90% for LI-RADS® CT/MRI, CEUS LI-RADS®, and ESCULAP [7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Although first studies suggest good diagnostic accuracy of the new standardized CEUS algorithms, these algorithms have not yet been validated in a prospective real-life setting [7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Real-life assessment of standardized contrast-enhanced ultrasound (CEUS) and CEUS algorithms (CEUS LI-RADS®/ESCULAP) in hepatic nodules in cirrhotic patients—a prospective multicenter study

et al. 2021

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Objectives Hepatocellular carcinoma (HCC) can be diagnosed non-invasively with contrast-enhanced ultrasound (CEUS) in cirrhosis if the characteristic pattern of arterial phase hyperenhancement followed by hypoenhancement is present. Recent studies suggest that diagnosis based on this “hyper-hypo” pattern needs further refinement. This study compares the diagnostic accuracies of standardized CEUS for HCC according to the current guideline definition and following the newly developed CEUS algorithms (CEUS LI-RADS®, ESCULAP) in a prospective multicenter real-life setting. Methods Cirrhotic patients with liver lesions on B-mode ultrasound were recruited prospectively from 04/2018 to 04/2019, and clinical and imaging data were collected. The CEUS standard included an additional examination point after 4–6 min in case of no washout after 3 min. The diagnostic accuracies of CEUS following the guidelines (“hyper-hypo” pattern), based on the examiner’s subjective interpretation (“CEUS subjective”), and based on the CEUS algorithms ESCULAP and CEUS LI-RADS® were compared. Results In total, 470 cirrhotic patients were recruited in 43 centers. The final diagnosis was HCC in 378 cases (80.4%) according to the reference standard (histology 77.4%, MRI 16.4%, CT 6.2%). The “hyper-hypo” pattern yielded 74.3% sensitivity and 63% specificity. “CEUS subjective” showed a higher diagnostic accuracy (sensitivity, 91.5%; specificity, 67.4%; positive predictive value, 92%; negative predictive value, 66%). Sensitivity was higher for ESCULAP (95%) and “CEUS subjective” (91.5%) versus CEUS LI-RADS® (65.2%; p < 0.001). Specificity was highest for CEUS LI-RADS® (78.6%; p < 0.001). Conclusions CEUS has an excellent diagnostic accuracy for the non-invasive diagnosis of HCC in cirrhosis. CEUS algorithms may be a helpful refinement of the “hyper-hypo” pattern defined by current HCC guidelines. Key Points • Contrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy for the non-invasive diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. • The CEUS algorithm ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) showed the highest sensitivity, whereas the CEUS LI-RADS® (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System) algorithm yielded the highest specificity. • A standardized CEUS examination procedure with an additional examination point in the late phase, after 4–6 min in lesions with no washout after 3 min, is vital.

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Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS

et al. 2018

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• CEUS-LI-RADS and MRI-LIRADS enable standardized non-invasive diagnosis of HCC in high-risk patients. • With CEUS, interobserver agreement is better for arterial hyperenhancement than for "washout". • Interobserver agreement for major features is moderate for both CEUS and MRI. • Interobserver agreement for LI-RADS category is substantial for MRI, and fair for CEUS. • Interobserver-agreement for CEUS-LI-RADS will presumably improve with ongoing use of the algorithm.

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LI-RADS-CEUS – proposal for a contrast-enhanced ultrasound algorithm for the diagnosis of hepatocellular carcinoma in high-risk populations

Cited by 27 publications

References 0 publications

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

Real-life assessment of standardized contrast-enhanced ultrasound (CEUS) and CEUS algorithms (CEUS LI-RADS®/ESCULAP) in hepatic nodules in cirrhotic patients—a prospective multicenter study

Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS

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