Using new criteria to improve the differentiation between HCC and non-HCC malignancies: clinical practice and discussion in CEUS LI-RADS 2017

Zhang, Dan; Xu, Ming; Liang, Jun; Cheng, Minquan; Huang, Hui; Pan, Jia-Ming; Huang, Yang; Tong, Wenjuan; Xie, Xian-Jin; Lü, Ming-De; Chen, Li-Da; Hu, Hang-Tong; Wang, Wei

doi:10.1007/s11547-021-01417-w

Cited by 22 publications

(32 citation statements)

References 14 publications

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“…In particular, a multicentre retrospective study published by Terzi et al [ 22 ] reported that about 40% of LR-M lesions were HCCs. Another study by Wilson et al [ 16 ] identified that 35% of HCCs were reported to be LR-M. Several other authors have attempted to decrease the risk of HCC misdiagnosis by proposing a modified LR-M class of risk with the introduction of new criteria, such as the shortening of washout timing to < 45 s or the possibility to detect a significant washout to < 3 min[ 42 - 44 ]. Interestingly, Chen et al [ 45 ] were able to reduce the ICC misdiagnosis rate with CEUS LR-M from 38 to 12 cases by considering other criteria such as the presence of an intratumoral vein or an unclear boundary of the intratumoral non-enhanced area.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound Liver Imaging Reporting and Data System: Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

Vidili¹,

Arru²,

Solinas³

et al. 2022

WJG

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BACKGROUND Contrast-enhanced ultrasound (CEUS) is considered a secondary examination compared to computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of hepatocellular carcinoma (HCC), due to the risk of misdiagnosing intrahepatic cholangiocarcinoma (ICC). The introduction of CEUS Liver Imaging Reporting and Data System (CEUS LI-RADS) might overcome this limitation. Even though data from the literature seems promising, its reliability in real-life context has not been well-established yet. AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis. METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis. The diagnostic standard for all nodules was either biopsy (102 nodules) or CT/MRI (409 nodules). Common diagnostic accuracy indexes such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for the following associations: CEUS LR-5 and HCC; CEUS LR-4 and 5 merged class and HCC; CEUS LR-M and ICC; and CEUS LR-3 and malignancy. The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined. Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated. RESULTS CEUS LR-5 predicted HCC with a 67.6% sensitivity, 97.7% specificity, and 99.3% PPV ( P < 0.001). The merging of LR-4 and 5 offered an improved 93.9% sensitivity in HCC diagnosis with a 94.3% specificity and 98.8% PPV ( P < 0.001). CEUS LR-M predicted ICC with a 91.3% sensitivity, 96.7% specificity, and 99.6% NPV ( P < 0.001). CEUS LR-3 predominantly included benign lesions (only 28.8% of malignancies). In this class, the hypo-hypo pattern showed a much higher rate of malignant lesions (73.3%) than the iso-iso pattern (2.6%). Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect ( n = 511, k = 0.94, P < 0.001), while the agreement among raters from separate centres was substantial ( n = 50, k = 0.67, P < 0.001). Agreement was stronger for arterial phase hyperenhancement (internal k = 0.86, P < 2.7 × 10 -214 ; external k = 0.8, P < 0.001) than washout (internal k = 0.79, P < 1.6 × 10 -202 ; external k = 0.71, P < 0.001). CONCLUSION CEUS LI-RADS is effective but can be improved by merging LR-4 and 5 to diagnose...

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound Liver Imaging Reporting and Data System: Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

Vidili¹,

Arru²,

Solinas³

et al. 2022

WJG

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“…During CEUS assessment, ICC could show hyperenhancement during the arterial phase ( Figure 3 ) with washout. According to several authors, ICC washout at its earliest stage is comparable to HCC, and this finding should guide a correct diagnosis [ 82 , 83 , 84 ].…”

Section: Resultsmentioning

confidence: 99%

Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma

et al. 2023

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Background: This paper offers an assessment of radiomics tools in the evaluation of intrahepatic cholangiocarcinoma. Methods: The PubMed database was searched for papers published in the English language no earlier than October 2022. Results: We found 236 studies, and 37 satisfied our research criteria. Several studies addressed multidisciplinary topics, especially diagnosis, prognosis, response to therapy, and prediction of staging (TNM) or pathomorphological patterns. In this review, we have covered diagnostic tools developed through machine learning, deep learning, and neural network for the recurrence and prediction of biological characteristics. The majority of the studies were retrospective. Conclusions: It is possible to conclude that many performing models have been developed to make differential diagnosis easier for radiologists to predict recurrence and genomic patterns. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice.

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“…If early washout time was adjusted to <45s, the specificity of diagnosing HCC significantly increased to 95.61%, and the incidence of HCC misdiagnosed as ICC decreased from 12.3% to 4.4% [6]. However, another study did not show similar results; that is, the modified LR-5 had increased sensitivity and decreased specificity for the diagnosis of HCC [32]. The reason for analyzing this difference was that the non-HCC tumors included in the LR-M category were different in the two studies due to the highly similar CEUS findings of HCC and ICC.…”

Section: Potential For Ceus Li-rads Classificationmentioning

confidence: 96%

Contrast-enhanced ultrasound demonstrates greater adjuvant potential: past, current status, and future applications in Hepatocellular carcinoma early diagnosis

NIE

Wang

et al. 2023

Med Ultrason

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Hepatocellular carcinoma (HCC) has an atypical onset of clinical symptoms and a rapid tumor progression. The majority of patients with HCC are already in the late stages of the disease when they are diagnosed, limiting them to the best available treatments. Contrast-enhanced ultrasound (CEUS) has achieved significant advances in the diagnosis of HCC, including the detection of small lesions, the investigation of more beneficial contrast agents, and the use of CEUS-based radiomics. The purpose of this review is to discuss the relevant research and future challenges of CEUS in the early detection of HCC, to advise more accurate therapy.

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Using new criteria to improve the differentiation between HCC and non-HCC malignancies: clinical practice and discussion in CEUS LI-RADS 2017

Cited by 22 publications

References 14 publications

Contrast-enhanced ultrasound Liver Imaging Reporting and Data System: Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

Contrast-enhanced ultrasound Liver Imaging Reporting and Data System: Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma

Contrast-enhanced ultrasound demonstrates greater adjuvant potential: past, current status, and future applications in Hepatocellular carcinoma early diagnosis

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