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An assessment of liver lesions using a combination of CEUS LI-RADS and AFP

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To improve noninvasive diagnosis of HCC using a combination of CE US LI-RADS and alpha-fetoprotein (AFP).

Methods

757 solitary liver nodules from 757 patients at risk of HCC with CE US and serum AFP test were categorized as LR-1 to LR-5 through LR-M according to CE US LI-RADS version 2017. In LR-3, LR-4, and LR-M nodules, those with AFP > 200 ng/ml were reclassified as mLR-5. Nodules with LR-5 and mLR-5 were reclassified as definitely HCC to modify CE US LI-RADS. Diagnostic performance was assessed with specificity, sensitivity, and PPV.

Results

The sensitivity, specificity, and PPV of LR-5 as a predictor of HCC were 64.7%, 97.8%, and 98.9%, respectively. 32.1% patients with solitary liver nodule had AFP greater than 200 ng/ml, of which 98.8% were HCC (25.8%, 7.5%, 2.5% assigned to LR-M, LR-4, LR-3, respectively) and 1.2% were Combined Hepatocellular Cholangiocarcinoma. After modification, the sensitivity increased to 79.6% (P < 0.001), while specificity and PPV remained high (96.6% and 98.7%, P > 0.050).

Conclusion

The combination of CE US LI-RADS and AFP for diagnosing HCC improved diagnostic sensitivity significantly, while maintaining high PPV and specificity in patients with the solitary liver nodule.

Graphical abstract

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Abbreviations

AFP:

Alpha-fetoprotein

AML:

Angiomyolipoma

APHE:

Arterial phase hyperenhancement

CHC:

Combined hepatocellular cholangiocarcinoma

CE:

Contrast enhanced

CI:

Confidence interval

FLL:

Focal liver lesions

FNH:

Focal nodular hyperplasia

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MLC:

Metastatic liver cancer

NPV:

Negative predictive value

PPV:

Positive predictive value

TIV:

Tumor in vein

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Funding

This study was supported by the National Nature Science Foundation of China (Nos. 81971630, 82171960 and 82102078), Guangdong Natural Science Foundation (No. 2021B1515020054), and Guangzhou Science and Technology Project (No. 201904010187).

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Author notes

  1. Chao-qun Li and Hui Huang have contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, NO. 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China

    Chao-qun Li, Hui Huang, Si-min Ruan, Hang-tong Hu, Meng-fei Xian, Xiao-yan Xie, Ming-de Lu, Ming Kuang & Li-da Chen

  2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Ming-de Lu & Ming Kuang

  3. Department of Medical Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang West Road, Guangzhou, 510120, China

    Ying Wang

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  1. Chao-qun Li
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Correspondence to Ying Wang or Li-da Chen.

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There are no conflicts of interest to declare.

Ethical approval

Our study was approved by the institutional ethics committee of the first affiliated hospital of Sun Yat-sen University, and written informed consent was obtained from each patient for CEUS examination.

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Li, Cq., Huang, H., Ruan, Sm. et al. An assessment of liver lesions using a combination of CEUS LI-RADS and AFP. Abdom Radiol 47, 1311–1320 (2022). https://doi.org/10.1007/s00261-022-03428-1

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