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Evaluation of contrast-enhanced ultrasound LI-RADS version 2017: application on 271 liver nodules in individuals with non-alcoholic steatohepatitis

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Abstract

Objectives

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) version 2017 in a population with non-alcoholic steatohepatitis (NASH).

Methods

Between January 2013 and December 2020, consecutive patients diagnosed with NASH with untreated liver nodules were enrolled in this retrospective study. A prospective evaluation was performed between January 2021 and August 2021 as a validation set. Diagnostic performance was assessed.

Results

We included 217 nodules in 211 patients (mean age, 49.7 ± 21.7 years; male, 156) in the retrospective study. The positive predictive value (PPV) of CEUS LR-5 in the diagnosis of hepatocellular carcinoma (HCC) was 70.8% (56/79). In total, 28 of 217 (12.9%) nodules were classified as LR-M, of which 12 showed arterial phase hyper-enhancement, early washout, and absence of a punched-out appearance within 5 min; 10 of the 12 (83%) were HCC. When these nodules were reclassified as LR-5, the specificity of LR-M as a predictor of non-HCC malignancy increased from 91.0 (181/199) to 96.5% (192/199) (p = .023). Despite the reclassification, LR-5 specificity and PPV remained high (80.6% and 72.5%, respectively). Following reclassification, LR-M specificity increased from 90.0 (45/50) to 100% (50/50) (p = .022) in the validation set.

Conclusion

CEUS LI-RADS category LR-5 is effective in predicting the presence of HCC. In NASH patients, diagnostic performance can be further improved by reclassifying LR-M nodules with arterial phase hyper-enhancement, early washout, and punched-out appearance as LR-5.

Key Points

• The LI-RADS classification of CEUS has a high application value for differentiation of HCC in NASH patients.

• When LR-M nodules with arterial phase hyperenhancement and early washout but not punched-out appearance at < 5 min are reclassified as LR-5; the modification of LI-RADS has a better performance.

• The PPV of modified LR-5 in the non-cirrhotic group was better than that of LR-5. The PPV of modified CEUS LR-5 in the non-cirrhotic group was comparable to that in the cirrhotic group (p both = 0.065).

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic Steatohepatitis

PPV:

Positive predictive value

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Authors and Affiliations

  1. Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China

    Zhe Huang, PingPing Zhou, ShanShan Li & Kaiyan Li

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  1. Zhe Huang
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  2. PingPing Zhou
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  3. ShanShan Li
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  4. Kaiyan Li
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Correspondence to Kaiyan Li.

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The scientific guarantor of this publication is KaiYan Li.

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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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Huang, Z., Zhou, P., Li, S. et al. Evaluation of contrast-enhanced ultrasound LI-RADS version 2017: application on 271 liver nodules in individuals with non-alcoholic steatohepatitis. Eur Radiol 32, 7146–7154 (2022). https://doi.org/10.1007/s00330-022-08872-7

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  • DOI: https://doi.org/10.1007/s00330-022-08872-7

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