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Comparison between M-score and LR-M in the reporting system of contrast-enhanced ultrasound LI-RADS

  • Li-Da Chen
  • Si-Min Ruan
  • Yuan Lin
  • Jin-Yu Liang
  • Shun-Li Shen
  • Hang-Tong Hu
  • Yang Huang
  • Wei Li
  • Zhu Wang
  • Xiao-Yan Xie
  • Ming-De Lu
  • Ming Kuang
  • Wei Wang
Ultrasound

Abstract

Objective

To develop a contrast-enhanced ultrasound (CEUS) M-score and compare it with LR-M in CEUS Liver Imaging Reporting and Data System (LI-RADS).

Methods

We retrospectively enrolled 105 consecutive high-risk patients with hepatocellular carcinoma (HCC) and 105 with intrahepatic cholangiocarcinoma (ICC). The subjects were selected by propensity score matching between November 2003 and December 2017. A CEUS M-score for predicting ICC was constructed based on specific CEUS features by the least absolute shrinkage and selection operator regularised regression. M-score was used to develop a modified CEUS LI-RADS. The diagnostic performance of the modified CEUS LI-RADS using M-score for diagnosing HCC and ICC was compared with American College of Radiology (ACR) CEUS LI-RADS using LR-M.

Results

The most useful features for ICC were as follows: poorly circumscribed (69.52%), rim enhancement (63.81%), early washout (92.38%), intratumoural vein (56.19%), obscure boundary of intratumoural non-enhanced area (57.14%), and marked washout (59.05%, all p < 0.001). For predicting ICC, the M-score had a higher specificity (88.57% vs. 63.81%) with lower sensitivity (89.52% vs. 95.24%) compared with LR-M. For diagnosing HCC, the sensitivity of modified LI-RADS (80.95%) was much higher than that of ACR LI-RADS (57.14%), but the specificity was lower (90.48% vs. 96.19%). The area under the curve (AUC) of modified LI-RADS (0.857) was much higher than that of ACR LI-RADS (0.767, p = 0.0001). The modified positive predictive value (PPV) of ACR LI-RADS and modified LI-RADS were 99.42% and 98.99%, respectively.

Conclusions

The modified LI-RADS with M-score had higher sensitivity for diagnosing HCC and higher specificity for diagnosing ICC than ACR LI-RADS.

Key Points

• For predicting ICC, the M-score had a higher specificity (88.57% vs. 63.81%) with lower sensitivity (89.52% vs. 95.24%) compared with LR-M.

• A CEUS M-score for predicting ICC consisted of more detailed CEUS features (poorly circumscribed, rim enhancement, early washout, intratumoural vein, obscure boundary of intratumoural non-enhanced area, and marked washout) was constructed.

• For diagnosing HCC, the sensitivity of modified LI-RADS (80.95%) was much higher than that of ACR LI-RADS (57.14%), but the specificity was lower (90.48% vs. 96.19%). The modified positive predictive value (PPV) of ACR LI-RADS and modified LI-RADS were 99.42% and 98.99%, respectively.

Keywords

Ultrasonography Hepatocellular carcinoma (HCC) Hepatitis 

Abbreviations

AASLD

American Association for the Study of Liver Diseases

ACR

American College of Radiology

AFP

Alpha-fetoprotein

AUC

Area under the curve

BUS

Baseline ultrasound

CEUS

Contrast-enhanced ultrasound

HCC

Hepatocellular carcinoma

ICC

Intrahepatic cholangiocarcinoma

LASSO

Least absolute shrinkage and selection operator

LI-RADS

Liver Imaging Reporting and Data System

NPV

Negative predictive value

PPV

Positive predictive value

ROC

Receiver operating characteristic

Notes

Funding

This study has received funding by the National Nature Science Foundation of China (No: 81701719), the Guangdong Science and Technology Foundation (No: 2016A020215042), and the Guangdong Medical Scientific Research Foundation (No: 201611610484333).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Wei Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Li-Da Chen
    • 1
  • Si-Min Ruan
    • 1
  • Yuan Lin
    • 2
  • Jin-Yu Liang
    • 1
  • Shun-Li Shen
    • 3
  • Hang-Tong Hu
    • 1
  • Yang Huang
    • 1
  • Wei Li
    • 1
  • Zhu Wang
    • 1
  • Xiao-Yan Xie
    • 1
  • Ming-De Lu
    • 1
    • 3
  • Ming Kuang
    • 1
    • 3
  • Wei Wang
    • 1
  1. 1.Department of Medical UltrasonicsInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of PathologyThe First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  3. 3.Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina

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