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Contrast-enhanced ultrasound LI-RADS 2017: comparison with CT/MRI LI-RADS

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare the classification based on contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) with that of contrast-enhanced CT and MRI (CECT/MRI) LI-RADS for liver nodules in patients at high risk of hepatocellular carcinoma.

Methods

Two hundred thirty-nine patients with 273 nodules were enrolled in this retrospective study. Each nodule was categorized according to the CEUS LI-RADS version 2017 and CECT/MRI LI-RADS version 2017. The diagnostic performance of CEUS and CECT/MRI was compared. The reference standard was histopathology diagnosis. Inter-modality agreement was assessed with Cohen’s kappa.

Results

The inter-modality agreement for CEUS LI-RADS and CECT/MRI LI-RADS was fair with a kappa value of 0.319 (p < 0.001). The positive predictive values (PPVs) of hepatocellular carcinoma (HCC) in LR-5, LR-4, and LR-3 were 98.3%, 60.0%, and 25.0% in CEUS, and 95.9%, 65.7%, and 48.1% in CECT/MRI, respectively. The sensitivities and specificities of LR-5 for diagnosing HCC were 75.6% and 93.8% in CEUS, and 83.6% and 83.3% in CECT/MRI, respectively. The positive predictive values of non-HCC malignancy in CEUS LR-M and CECT/MRI LR-M were 33.9% and 93.3%, respectively. The sensitivity, specificity, and accuracy for diagnosing non-HCC malignancy were 90.9%, 84.5%, and 85.0% in CEUS LR-M and 63.6%, 99.6%, and 96.7% in CECT/MRI LR-M, respectively.

Conclusions

The inter-modality agreement of the LI-RADS category between CEUS and CECT/MRI is fair. The positive predictive values of HCCs in LR-5 of the CEUS and CECT/MRI LI-RADS are comparable. CECT/MRI LR-M has better diagnostic performance for non-HCC malignancy than CEUS LR-M.

Key Points

• The inter-modality agreement for the final LI-RADS category between CEUS and CECT/MRI is fair.

• The LR-5 of CEUS and CECT/MRI LI-RADS corresponds to comparable positive predictive values (PPVs) of HCC. For LR-3 and LR-4 nodules categorized by CECT/MRI, CEUS examination should be performed, at least if they can be detected on plain ultrasound.

• CECT/MRI LR-M has better diagnostic performance for non-HCC malignancy than CEUS LR-M. For LR-M nodules categorized by CEUS, re-evaluation by CECT/MRI is necessary.

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Abbreviations

ACR:

American College of Radiology

APHE:

Arterial phase hyperenhancement

CECT:

Contrast-enhanced computerized tomography

CEUS:

Contrast-enhanced ultrasound

CHC:

Combined hepatocellular cholangiocarcinoma

CPS/CHI:

Contrast pulse sequencing/contrast high-resolution imaging

EOB-MRI:

Gadoxetic acid–enhanced magnetic resonance imaging

FN:

False negative

FP:

False positive

HCC:

Hepatocellular carcinoma

HGDN:

High-grade dysplastic nodule

ICC:

Intrahepatic cholangiocarcinoma

LGDN:

Low-grade dysplastic nodule

LI-RADS:

Liver Imaging Reporting and Data System

LR:

Likelihood ratio

M:

Metastases

NPV:

Negative predictive value

PI:

Pulse inversion imaging

PPV:

Positive predictive value

RN:

Regenerative nodule

TN:

True negative

TP:

True positive

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Acknowledgments

The present work was supported by Tianjin Science and Technology Project (No. 17ZXMFSY00050) and Tianjin Science and Technology Project (No. 17ZXMFSY00170).

Funding

The authors state that this work has not received any funding.

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Author notes

  1. Jianmin Ding and Lei Long contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

    Jianmin Ding & Zhaoxiang Ye

  2. Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China

    Jianmin Ding, Lei Long, Hongyu Zhou, Yan Zhou, Yandong Wang & Xiang Jing

  3. Department of Radiology, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China

    Xiang Zhang & Chen Chen

  4. Department of Gastroenterology and Hepatology, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China

    Fengmei Wang

Authors
  1. Jianmin Ding
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Corresponding authors

Correspondence to Xiang Jing or Zhaoxiang Ye.

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The scientific guarantor of this publication is Xiang Jing.

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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.

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Ding, J., Long, L., Zhang, X. et al. Contrast-enhanced ultrasound LI-RADS 2017: comparison with CT/MRI LI-RADS. Eur Radiol 31, 847–854 (2021). https://doi.org/10.1007/s00330-020-07159-z

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  • DOI: https://doi.org/10.1007/s00330-020-07159-z

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