Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Ultrasound (US) Examination
2.3. Reference Standard
2.4. Contrast-Enhanced Ultrasound (CEUS) Image Assessment
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Distribution of Nodules in the Modified CEUS LI-RADS Categories
3.3. Imaging Characteristics of All Liver Nodules
3.4. Diagnostic Performance of the Modified CEUS LI-RADS LR-5 and LR-M Categories
3.5. Modified CEUS LI-RADS Categories and Degree of Histopathologic Differentiation of HCC
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Rating Criteria with Nodule Size | Arterial Phase | Early Washout (<60 s) or Not | Kupffer Phase (≥10 min) |
---|---|---|---|
LR-5 | |||
≥1 cm | Hyperenhancement (not rim, not peripheral discontinuous globular hyperenhancement) | No | Hypoechoic |
LR-M | |||
Nodule size not considered | Rim hyperenhancement or not rim, not peripheral discontinuous globular hyperenhancement | Yes | Hypoechoic |
LR-4 | |||
≥2 cm | No hyperenhancement | No | Hypoechoic |
≥1 cm | Not rim, not peripheral discontinuous globular hyperenhancement | No | Isoechoic or Hyperechoic |
<1 cm | Not rim, not peripheral discontinuous globular hyperenhancement | No | Hypoechoic |
LR-3 | |||
<2 cm | No hyperenhancement | No | Any |
≥2 cm | No hyperenhancement | No | Isoechoic or Hyperechoic |
<1 cm | Not rim, not peripheral discontinuous globular hyperenhancement | No | Isoechoic or Hyperechoic |
LR-2 | |||
<1 cm | Iso-enhancement | No | Isoechoic or Hyperechoic |
LR-1 | |||
Nodule size not considered | Definitely benign arterial phase pattern (cyst, hemangioma, focal fatty deposition/sparing, or other definitely benign finding) | No | N/A |
Characteristic | Result |
---|---|
Median age (y) * | 70.0 (54.5–78.0) |
Sex | |
Male | 74 (71.2%) |
Female | 30 (28.8%) |
Median nodule size (mm) * | 17.9 (13.1–28.2) |
Liver disease etiology | |
HCV | 36 (34.6%) |
HBV | 27 (26.0%) |
Alcohol | 26 (25.0%) |
NASH | 11 (10.6%) |
HCV + HBV | 1 (1.0%) |
AIH | 1 (1.0%) |
Unknown | 2 (1.9%) |
Presence of cirrhosis | 80 (87.9%) |
Histopathologic analysis | |
HCC | 64 (61.5%) |
Well-differentiated | 28 |
Moderately differentiated | 32 |
Poorly differentiated | 4 |
ICC | 6 (5.8%) |
Metastasis | 9 (8.7%) |
FNH | 5 (4.8%) |
Dysplastic nodule | 3 (2.9%) |
AML | 1 (1.0%) |
Focal fatty change | 1 (1.0%) |
Diffuse large B-cell lymphoma | 1 (1.0%) |
Adrenal rest tumor | 1 (1.0%) |
No histopathologic analysis | |
Contrast-enhanced CT or MRI and follow-up | |
Hemangioma | 10 (9.6%) |
FNH | 2 (1.9%) |
Focal spared lesion | 1 (1.0%) |
Category | No. of Nodules (% of total) | Percentage HCC | Percentage Non-HCC Malignancy | Histopathologic Analysis | Contrast-Enhanced CT or MRI and Follow-Up |
---|---|---|---|---|---|
LR-1 | 7 (6.7) | 0 | 0 | 0 | 7 |
LR-2 | 1 (1.0) | 0 | 0 | 1 | 0 |
LR-3 | 10 (9.6) | 70.0 (7/10) | 0 | 9 | 1 |
LR-4 | 16 (15.3) | 37.5 (6/16) | 0 | 13 | 3 |
LR-5 | 48 (46.2) | 93.8 (45/48) | 0 | 46 | 2 |
LR-M | 22 (21.2) | 27.3 (6/22) | 68.2 (15/22) | 22 | 0 |
Total Nodules (104) n (%) | LR-1 7 (6.7) | LR-2 1 (1.0%) | LR-3 10 (9.6%) | LR-4 16 (15.3%) | LR-5 48 (46.2%) | LR-M 22 (21.2%) |
---|---|---|---|---|---|---|
HCC | 0 | 0 | 7 (70.0%) | 6 (37.5%) | 45 (93.8%) | 6 (27.3%) |
Metastasis | 0 | 0 | 0 | 0 | 0 | 9 (40.9%) |
ICC | 0 | 0 | 0 | 0 | 0 | 6 (27.3%) |
Lymphoma | 0 | 0 | 0 | 0 | 0 | 1 (4.6%) |
Hemangioma | 6 (85.7%) | 0 | 0 | 2 (12.5%) | 2 (4.2%) | 0 |
FNH | 0 | 0 | 1 (10.0%) | 6 (37.5%) | 0 | 0 |
DN | 0 | 0 | 2 (20.0%) | 1 (6.3%) | 0 | 0 |
AML | 0 | 0 | 0 | 1 (6.3%) | 0 | 0 |
Adrenal rest tumor | 0 | 0 | 0 | 0 | 1 (2.1%) | 0 |
Focal fatty area | 0 | 1 (100%) | 0 | 0 | 0 | 0 |
Focal spread lesion | 1 (14.3%) | 0 | 0 | 0 | 0 | 0 |
Imaging Features | Malignant Lesions | Benign Lesions | Total (n = 104) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
HCC (n = 64) | Metastasis (n = 9) | ICC (n = 6) | Lymphoma (n = 1) | Hemangioma (n = 10) | FNH (n = 7) | DN (n = 3) | AML (n = 1) | Adrenal Rest Tumor (n = 1) | Focal Fatty Area (n = 1) | Focal Spared Lesion (n = 1) | ||
Gray-scale echogenicity | ||||||||||||
Hyperechoic | 13 | 3 | 1 | 0 | 2 | 3 | 1 | 0 | 1 | 1 | 0 | 25 |
Isoechoic | 10 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 13 |
Hypoechoic | 41 | 5 | 5 | 1 | 7 | 3 | 2 | 1 | 0 | 0 | 1 | 66 |
Arterial phase | ||||||||||||
Hyperenhancement | 56 | 2 | 5 | 1 | 7 | 7 | 1 | 1 | 1 | 0 | 0 | 81 |
Diffuse | 56 | 2 | 4 | 1 | 4 | 7 | 1 | 1 | 1 | 0 | 0 | 77 |
Rim | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Peripheral nodular | 0 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
Iso-enhancement | 7 | 4 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 14 |
Hypo-enhancement | 1 | 3 | 1 | 0 | 3 | 0 | 1 | 0 | 0 | 0 | 0 | 9 |
Kupffer phase | ||||||||||||
Isoechoic | 11 | 0 | 0 | 0 | 7 | 5 | 3 | 1 | 0 | 1 | 1 | 29 |
Hypoechoic | 53 | 9 | 6 | 1 | 3 | 0 | 0 | 0 | 1 | 0 | 0 | 73 |
Marked | 16 | 9 | 6 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 32 |
Mild | 37 | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 1 | 0 | 0 | 41 |
Hyperechoic | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 2 |
Washout | ||||||||||||
<60 s | 6 | 9 | 6 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 22 |
Criteria | Se (%) | 95% CI | Sp (%) | 95% CI | PPV (%) | 95% CI | NPV (%) | 95% CI | Accuracy (%) | 95% CI |
---|---|---|---|---|---|---|---|---|---|---|
LR-5 | 70.3 | 57.6–81.1 | 92.5 | 79.6–98.4 | 93.8 | 82.8–98.7 | 66.1 | 52.2–78.2 | 78.7 | 69.7–86.2 |
LR-M | 68.2 | 45.1–86.1 | 100 | 93.5–100 | 100 | 69.8–100 | 92.1 | 84.5–96.8 | 93.3 | 86.6–97.3 |
CEUS LI-RADS | Well-Differentiated | Moderately Differentiated | Poorly Differentiated |
---|---|---|---|
LR-3 | 6 | 1 | 0 |
LR-4 | 5 | 1 | 0 |
LR-5 | 17 | 28 | 0 |
LR-M | 0 | 2 | 4 |
Total | 28 | 32 | 4 |
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Sugimoto, K.; Kakegawa, T.; Takahashi, H.; Tomita, Y.; Abe, M.; Yoshimasu, Y.; Takeuchi, H.; Kasai, Y.; Itoi, T. Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid. Diagnostics 2020, 10, 828. https://doi.org/10.3390/diagnostics10100828
Sugimoto K, Kakegawa T, Takahashi H, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Kasai Y, Itoi T. Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid. Diagnostics. 2020; 10(10):828. https://doi.org/10.3390/diagnostics10100828
Chicago/Turabian StyleSugimoto, Katsutoshi, Tatsuya Kakegawa, Hiroshi Takahashi, Yusuke Tomita, Masakazu Abe, Yu Yoshimasu, Hirohito Takeuchi, Yoshitaka Kasai, and Takao Itoi. 2020. "Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid" Diagnostics 10, no. 10: 828. https://doi.org/10.3390/diagnostics10100828
APA StyleSugimoto, K., Kakegawa, T., Takahashi, H., Tomita, Y., Abe, M., Yoshimasu, Y., Takeuchi, H., Kasai, Y., & Itoi, T. (2020). Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid. Diagnostics, 10(10), 828. https://doi.org/10.3390/diagnostics10100828