Comparison of modified CEUS LI‐RADS with sonazoid and CT/MRI LI‐RADS for diagnosis of hepatocellular carcinoma

• Published in: Hepatology research Vol. 52; no. 8; pp. 730 - 738
• Main Authors: Sugimoto, Katsutoshi, Saito, Kazuhiro, Shirota, Natsuhiko, Kamiyama, Naohisa, Sakamaki, Kentaro, Takahashi, Hiroshi, Wada, Takuya, Kakegawa, Tatsuya, Tomita, Yusuke, Abe, Masakazu, Yoshimasu, Yu, Takeuchi, Hirohito, Itoi, Takao
• Format: Journal Article
• Language: English
• Published: Netherlands Wiley Subscription Services, Inc 01-08-2022
• Subjects: Computed tomography; contrast media; Hepatocellular carcinoma; Liver; LI‐RADS; Magnetic resonance imaging; Malignancy; Metastases; Nodules; sonazoid; ultrasound; sonazoid; LI-RADS; hepatocellular carcinoma; ultrasound; contrast media
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.13793

Aim
To compare the diagnostic performance based on the modified CEUS Liver Imaging Reporting and Data System (LI‐RADS), which includes Kupffer‐phase findings as a major imaging feature, with that of CT and MRI (CT/MRI) LI‐RADS for liver nodules in patients at high risk of HCC.
Methods
A total of 120 patients with 120 nodules were included in this retrospective study. The median size of the lesions was 20.0 mm (interquartile range, 14.0–30.8 mm). Of these lesions, 90.0% (108 of 120) were confirmed as HCCs, 6.7% (8 of 120) were intrahepatic cholangiocarcinomas, 1.7% (2 of 120) were metastases, and 1.7% (2 of 120) were dysplastic nodules. All nodules were diagnosed histopathologically. Each nodule was categorized according to the modified CEUS LI‐RADS and CT/MRI LI‐RADS version 2018. The diagnostic performance and inter‐modality agreement of each criterion was compared.
Results
The inter‐modality agreement for the modified CEUS LI‐RADS and CT/MRI LI‐RADS was slight agreement (kappa = 0.139, p = 0.015). The diagnostic accuracies of HCCs for the modified CEUS LR‐5 and CT/MRI LR‐5 were 70.0% (95% confidence interval [CI]: 61.0%, 78.0%) versus 70.8% (95% CI: 61.8%, 78.8%) (p = 0.876), respectively. The diagnostic accuracies of non‐HCC malignancies for the modified CEUS LR‐M and CT/MRI LR‐M were 84.2% (95% CI: 76.4%, 90.2%) versus 96.7% (95% CI: 91.7%, 99.1%) (p = 0.002), respectively.
Conclusions
The diagnostic performance for HCCs on the modified CEUS LR‐5 and CT/MRI LR‐5 are comparable. In contrast, CT/MRI LR‐M has better diagnostic performance for non‐HCC malignancy than that of the modified CEUS LR‐M.