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Additional value of contrast-enhanced ultrasound (CEUS) on arterial phase non-hyperenhancement observations (≥ 2 cm) of CT/MRI for high-risk patients: focusing on the CT/MRI LI-RADS categories LR-3 and LR-4

  • Hepatobiliary
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Abstract

Purpose

To determine the added value of CEUS on arterial phase non-hyperenhancement (APNHE) observations (LR-3 and LR-4) of CT/MRI in high-risk patients.

Methods

Forty-three patients with APNHE observations (≥ 2 cm) from CT/MRI were prospectively enrolled in this IRB-approved study and underwent CEUS. All observations were assessed by LI-RADS for CT/MRI and CEUS. The hemodynamic findings were compared. The mean follow-up period was 11.8 ± 2.1 months. Reference standard was made on 34-APNHE observations based on biopsy (n = 2), surgery (n = 2), and follow-up image (n = 30).

Results

The median of observation size was 2.3 cm (IQR 2.0–2.5 cm). Among the 43-APNHE observations, 12-observations (27.9%) were further presented as arterial phase hyperenhancement (APHE) in CEUS with early (n = 1, CEUS LR-M), late (n = 10, CEUS LR-5), or no (n = 1, CEUS LR-4) washout. Compared to CT, CEUS presented concordant enhancement patterns in 16 (44.4%) in AP and 20 (55.6%) in PVP, respectively. Similarly, 13 (59.1%) and 14 (63.6%) observations showed concordant enhancement patterns between CEUS and MRI in AP and PVP, respectively. Of the 34-APNHE observations with final diagnosis (hepatocellular carcinoma [HCC] n = 12; intrahepatic cholangiocarcinoma [IHCC], n = 1; non-malignancy, n = 21), 4 HCCs (33.3%) and 1 IHCC (100%) were additionally diagnosed by CEUS, while 1 non-malignant lesion (4.5%) was misdiagnosed as HCC by CEUS.

Conclusion

Adding CEUS to APNHE observations from CT/MRI would be useful not only for definitely diagnosing HCC (CEUS LR-5) but also for other malignancies (CEUS LR-M). The discordance of dynamic features between the LI-RADS for CEUS and CT/MRI may reflect the different properties of contrast media, although the systems are not interchangeable.

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Abbreviations

AP:

Arterial phase

APHE:

Arterial phase hyperenhancement

APNHE:

Arterial phase non-hyperenhancement

CEUS:

Contrast-enhanced ultrasound

CT:

Computed tomography

DP:

Delayed phase

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver imaging reporting and data system

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

SD:

Standard deviation

US:

Ultrasound

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Acknowledgement

We thank to Hyeon-Jin Kim (Seoul, Korea) for her assistance. We thank Bonnie Hami, M.A. (USA) for her editorial assistance in the preparation of this manuscript. We thanked Yoon Hee Choi in the Medical Research Collaborating Center (MRCC) (Seoul National University Hospital, Seoul, Korea) for her statistical assistance.

Funding

This research was partially supported by an academic research fund of the Korean Liver Cancer Study for 2017 and a research grant from SAMSUNG MEDISON Co., Ltd.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea

    Hyo-Jin Kang, Jung Hoon Kim, Ijin Joo & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea

    Hyo-Jin Kang, Jung Hoon Kim, Ijin Joo & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, South Korea

    Jung Hoon Kim & Joon Koo Han

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  1. Hyo-Jin Kang
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Correspondence to Jung Hoon Kim.

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Ethical approval

This prospective study was approved by the Institutional Review Board of our hospital (IRB; No 1703-171-842), and all patients provided written informed consent for participation in this study.

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Kang, HJ., Kim, J.H., Joo, I. et al. Additional value of contrast-enhanced ultrasound (CEUS) on arterial phase non-hyperenhancement observations (≥ 2 cm) of CT/MRI for high-risk patients: focusing on the CT/MRI LI-RADS categories LR-3 and LR-4. Abdom Radiol 45, 55–63 (2020). https://doi.org/10.1007/s00261-019-02132-x

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  • DOI: https://doi.org/10.1007/s00261-019-02132-x

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