Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid

Abstract

The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Patients with chronic liver disease at risk for HCC were evaluated retrospectively. Nodules ≥1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and contrast defects in the Kupffer phase were classified as LR-5. Nodules showing early washout, contrast defects in the Kupffer phase, and/or rim enhancement were classified as LR-M. A total of 104 nodules in 104 patients (median age: 70.0 years; interquartile range: 54.5–78.0 years; 74 men) were evaluated. The 48 (46.2%) LR-5 lesions included 45 HCCs, 2 high-flow hemangiomas, and 1 adrenal rest tumor. The PPV of LR-5 for HCC was 93.8% (95% confidence interval (CI): 82.8%–98.7%). The 22 (21.2%) LR-M lesions included 16 non-HCC malignancies and 6 HCCs. The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8%–100%). In conclusion, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively.

Noninvasive Diagnosis of Hepatocellular Carcinoma on Sonazoid-Enhanced US: Value of the Kupffer Phase

“…To overcome this inconvenience, a modified CEUS LI-RADS that is also applicable to Sonazoid was developed [ 6 ]. The main difference between CEUS LI-RADS (2017 version) and the modified CEUS LI-RADS is that the former includes portal- and late-phase washout as a major imaging feature, while the latter includes Kupffer-phase findings as a major imaging feature.…”

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

“…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 ].…”

“…One limitation of this study regarding the assessment of AFs could be the fact that CEUS was perfomed by using only one contrast agent (SonoVue), while other agents could provide additional Kupffer phase images [ 10 , 28 ]. Future studies should assess AFs through comparing different contrast agents.…”

Abdominal Ultrasound and Treatment of Hepatocellular Carcinoma

“…Unlike pure blood pool contrast agents, combined blood pool and Kupffer cell contrast agents have a post-vascular phase, which is defined as occurring about 10 min after injection. As liver lesions that have decreased or no Kupffer cells appearing as defective areas during the post-vascular phase of CEUS with Sonazoid, Sugimoto et al defined that nodules ≤ 1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and defective areas in the post-vascular phase should be classified as LR-5 [ 10 ]. Liver lesions showing early washout, defective areas in the post-vascular phase, and/or rim enhancement in the arterial phase were classified as LR-M. A total of 104 lesions in 104 patients were evaluated.…”

“…The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8–100%). Therefore, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively [ 10 ]. Similar to this result, we have to ensure that poorly differentiated HCC has the tendency to exhibit an early washout, as evaluated by CEUS with Sonazoid [ 11 ].…”