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Performance of current versus modified CEUS LI-RADS in the diagnosis of non-hepatocellular carcinoma malignancies

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope

Abstract

Purpose

The high proportion of HCC in CEUS LR-M decreases the sensitivity of LR-5 for the diagnosis of HCC. However, when modifying LR-M criteria to further improve the sensitivity of LR-5, it is also important not to compromise the diagnostic performance (especially sensitivity) of LR-M for non-hepatocellular carcinoma malignancies (non-HCCMs). The purpose of this study was to evaluate the diagnostic performance of CEUS LI-RADS (2017 version) for non-HCCMs and to explore the impact of modified CEUS LI-RADS on the diagnostic performance of LR-M.

Methods

In this retrospective study, patients with pathologically confirmed non-HCCMs were evaluated. Two radiologists independently interpreted the major CEUS features and categorized the liver lesions. New LR-M criteria were applied: early washout (< 45 s) or marked washout (< 5 min). The sensitivity values of the current and modified CEUS LR-M were assessed and then compared using a paired χ2 test. Cohen’s κ was used to compare the inter-reader agreement of the LI-RADS categories.

Results

A total of 131 non-HCCMs were ultimately selected, including 71 intrahepatic cholangiocarcinomas, 26 combined hepatocellular cholangiocarcinomas, 29 metastases, and 5 other non-HCCMs. The numbers of LR-M, LR-5, LR-4, and LR-3 in liver lesions were 111, 18, 1, and 1, respectively. The inter-reader agreement of the LI-RADS categories for non-HCCMs was 0.59. The sensitivity of the current CEUS LR-M in diagnosing non-HCCMs was 84.7%. By adjusting the early washout time to < 45 s, the sensitivity of LR-M was 80.9%. By adjusting the marked washout time within 5 min, the sensitivity of LR-M was 72.5%.

Conclusion

CEUS LR-M has high sensitivity in diagnosing non-HCCMs. For LR-M nodules with nonrim arterial phase hyperenhancement and early washout, advancing the time of early washout to < 45 s has a minimal impact on the sensitivity of LR-M in diagnosing non-HCCMs compared to the condition of increasing the marked washout within 5 min.

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Acknowledgements

We thank the Laboratory of Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, Key Laboratory of Ultrasonic Molecular Imaging and Artificial Intelligence, Guangxi Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor/Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumor (Guangxi Medical University), and Ministry of Education for their support of this study.

Funding

This study was funded by the National Natural Science Foundation of China (No. 82160336), the Natural Science Foundation of Guangxi, China (No. 2020GXNSFDA238005) and the Nanning Qingxiu District Science and Technology Plan (No. 2020045).

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Author notes

  1. Rong Wen and Fen Huang have contributed equally as first authors.

Authors and Affiliations

  1. Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuangzu, People’s Republic of China

    Rong Wen, Fen Huang, Peng Lin, Ruizhi Gao, Jinshu Pang, Yuquan Wu, Haihui Yin, Zhiping Tang, Yun He & Hong Yang

  2. Department of Medical Ultrasound, Guangxi International Zhuang Medical Hospital, Nanning, Guangxi Zhuangzu, People’s Republic of China

    Zhen Ma

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Contributions

Study concepts and design: RW and HY. Literature research: FH, JSP, and RZG. Methodology: PL. Data analysis: RW and YQW. Statistical analysis: HHY, ZPT, and ZM. Manuscript preparation: RW and FH. Manuscript editing: HY and YH. Study supervision: HY and YH.

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Correspondence to Hong Yang.

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This is an observational study. Approval was granted by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University.

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Wen, R., Huang, F., Lin, P. et al. Performance of current versus modified CEUS LI-RADS in the diagnosis of non-hepatocellular carcinoma malignancies. Abdom Radiol 48, 3688–3695 (2023). https://doi.org/10.1007/s00261-023-04043-4

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