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Combining serum AFP and CEUS LI-RADS for better diagnostic performance in Chinese high-risk patients

  • Abdominal Radiology
  • Published:
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Abstract

Purpose

To evaluate and compare the diagnostic performance of revised contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System version by combining LR-M category and serum alpha-fetoprotein (AFP) under different cut-off values.

Material and methods

This retrospective study enrolled 152 high-risk patients with 152 histology-proven nodules. For revised LI-RADS, nodules in LR-M with different elevated AFP thresholds have been reclassified as the LR-5 category. The diagnostic performances of original and revised CEUS LI-RADS were evaluated and compared.

Results

To compare with the original version, the sensitivity of revised LR-5 (adjusted with AFP value > 200 ng/ml or 400 ng/ml) for the diagnosis of hepatocellular carcinoma (HCC) improved from 52.5 to 69.2% or 65.0%, respectively (both p < 0.001) without compromising specificity (87.5% vs. 71.9% or 78.1%, respectively, both p > 0.05). For the diagnosis of non-HCC malignancy, the specificity of the LR-M after reclassification was improved (69.6% vs. 84.4% or 80.7%, respectively, both p < 0.001) with a non-significant sensitivity reduction (100.0 vs. 70.6% or 82.4%, respectively, both p > 0.05). After modification, the sensitivity of LR-5 also increased to 69.1% or 64.9% (both p < 0.001), while the specificity and PPV did not change (both p > 0.05) for larger nodules (> 20 mm).

Conclusion

The diagnostic performance of CEUS LI-RADS can be further improved by reclassifying LR-M nodules with elevated AFP thresholds to LR-5.

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Abbreviations

ACR:

American college of radiology

AFP:

Alpha-fetoprotein

AUC:

Area under the ROC curve

CEUS:

Contrast-enhanced ultrasound

CHC:

Combined hepatocellular cholangiocarcinoma

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

ICC:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver imaging reporting and data system

MLC:

Metastasis liver carcinoma

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

US:

Ultrasound

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Funding

This work was supported by National Natural Science Foundation of China for Youth Scholars (Grant No. 82202241); Heilongjiang Postdoctoral Science Foundation (Grant No. LBH-Z21022); Innovative Research Project of Harbin Medical University (Grant No. 31041210025).

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Author notes

  1. Wushuang Gong and Jiaqi Wu were contributed equally to this manuscript.

Authors and Affiliations

  1. In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeons’ Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang, China

    Wushuang Gong, Jiaqi Wu, Hong Wei, Zhaopeng Jiang, Ming Wan, Chengwei Wu, Weili Xue, Rao Ma, Xianli Zhou & Hang Zhou

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  1. Wushuang Gong
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Contributions

Conceptualization: JW; Data curation: WG, RM; Formal analysis: HW, RM; Funding acquisition: HZ; Investigation: JW, CW; Methodology: MW, WX; Project administration: HZ, XZ; Resources: JW, HW; Software: ZJ, WX; Supervision: HZ, XZ; Validation: MW, CW; Visualization: ZJ; Writing-original draft: WG, HZ; Writing-review and editing: WG, JW, HZ; all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xianli Zhou or Hang Zhou.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee the Second Affiliated Hospital of Harbin Medical University.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Written informed consent was waived by the Institutional Review Board of the Second Affiliated Hospital of Harbin Medical University.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 3 and 4.

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Gong, W., Wu, J., Wei, H. et al. Combining serum AFP and CEUS LI-RADS for better diagnostic performance in Chinese high-risk patients. Radiol med 128, 393–401 (2023). https://doi.org/10.1007/s11547-023-01614-9

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