Download PDF
Ultraschall Med 2022; 43(01): 64-71
DOI: 10.1055/a-1168-6321
Original Article

Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Diagnosing Hepatocellular Carcinoma: Diagnostic Performance and Interobserver Agreement

Berichts- und Datensystem für kontrastverstärkten Ultraschall in der Leberbildgebung (CEUS-LI-RADS) für die Diagnose des hepatozellulären Karzinoms: Diagnostische Leistung und Interobserver-Übereinstimmung
Hang Zhou
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
,
Chao Zhang
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
,
Linyao Du
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Jiapeng Jiang
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
,
Qing Zhao
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Jiawei Sun
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Qunying Li
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
,
Ming Wan
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Xiaolei Wang
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Xiujuan Hou
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Qing Wen
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
,
Yajing Liu
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
,
Xianli Zhou
2   In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
,
Pintong Huang
1   Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objectives To determine the diagnostic performance and inter-reader agreement of the contrast-enhanced ultrasound liver imaging reporting and data system (CEUS-LI-RADS) for diagnosing hepatocellular carcinoma (HCC) in high-risk patients.

Methods In this prospective study, CEUS-LI-RADS categories (LR-5 for predicting HCC) were assigned by six blinded readers and compared to the definitive HCC diagnosis in patients with liver cirrhosis per the 2017 China Liver Cancer Guidelines (CLCG). CEUS features were recorded in 96 patients with 96 histology-proven lesions. The diagnostic performance of LR-5 was described by the sensitivity, specificity and accuracy. Multi-reader agreement was assessed by using intraclass correlation coefficients (ICC).

Results In cirrhotic patients, the specificity of LR-5 (range: 92.7–100.0 %) was statistically higher than that of CLCG for each reader (range: 28.6–64.3 %). However, the sensitivity (range: 38.6–63.6 %) and accuracy (range: 53.4–70.7 %) were statistically lower in CEUS-LIRADS than in CLCG (sensitivity range: 88.6–100.0 %; accuracy range: 77.6–86.2 %). Only fair to moderate inter-reader agreement was achieved for the CEUS-LI-RADS category (ICC = 0.595) and washout appearance (ICC range: 0.338 to 0.555). Neither nodule-in-nodule nor mosaic architecture was observed more often in HCC (all P > 0.05), with poor inter-reader consistency for both (both ICC < 0.20).

Conclusion CEUS-LI-RADS category 5 has a high specificity but a low accuracy for identifying HCC in high-risk patients. Inter-reader agreement is not satisfactory concerning CEUS-LIRADS category and washout appearance. Moreover, the clinical value of ancillary features favoring HCC is quite limited.

Zusammenfassung

Ziel Bestimmung der diagnostischen Leistungsfähigkeit und der Interreader-Übereinstimmung von CEUS-LI-RADS (Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System) in einem Berichts- und Datensystem für kontrastverstärkten Ultraschall in der Leberbildgebung zur Diagnose des hepatozellulären Karzinoms (HCC) bei Hochrisikopatienten.

Methoden In dieser prospektiven Studie wurden die CEUS-LI-RADS-Kategorien (LR-5 zur Vorhersage des HCC) von 6 verblindeten Beobachtern zugeordnet und mit der definitiven HCC-Diagnose bei Patienten mit Leberzirrhose nach den 2017 China Liver Cancer Guidelines (CLCG) verglichen. CEUS-Merkmale wurden bei 96 Patienten mit 96 histologisch nachgewiesenen Läsionen bestimmt. Die diagnostische Leistung von LR-5 wurde durch Sensitivität, Spezifität und Genauigkeit beschrieben. Die Multireader-Übereinstimmung wurde mittels Intraklassenkorrelationskoeffizient (ICC) bewertet.

Ergebnisse Bei zirrhotischen Patienten war die Spezifität von LR-5 (Bereich: 92,7–100,0 %) für jeden Beobachter statistisch höher als bei CLCG (28,6–64,3 %). Allerdings waren die Sensitivität (Bereich: 38,6–63,6 %) und die Genauigkeit (53,4–70,7 %) bei CEUS-LI-RADS statistisch gesehen niedriger als bei CLCG (Sensitivität: 88,6–100,0 %; Genauigkeit: 77,6–86,2 %). Für die CEUS-LI-RADS-Kategorie (ICC = 0,595) und die Wash-out-Charakterisierung (ICC: 0,338–0,555) wurde nur eine geringe bis moderate Übereinstimmung zwischen den Beobachtern erzielt. Weder Knoten-in-Knoten noch Mosaik-Architektur wurde bei HCC häufiger beobachtet (jeweils p > 0,05), wobei die Übereinstimmung zwischen den Beobachtern bei beiden Parametern schlecht war (jeweils ICC< 0,20).

Schlussfolgerung Die CEUS-LI-RADS-Kategorie 5 weist eine hohe Spezifität, aber eine geringe Genauigkeit bei der Identifizierung des HCC bei Hochrisikopatienten auf. Die Interreader-Übereinstimmung ist nicht zufriedenstellend bezüglich der CEUS-LI-RADS-Kategorie und der Wash-out-Charakterisierung. Darüber hinaus ist der klinische Wert von Hilfsmarkern, die für eine HCC sprechen, recht begrenzt.

Key words

liver - liver imaging - liver cancer

Supplement



Publication History

Received: 26 August 2019

Accepted: 14 April 2020

Article published online:
08 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Letter to the Editor Regarding the Article “Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Diagnosing Hepatocellular Carcinoma: Diagnostic Performance and Interobserver Agreement” by Zhou and CollaboratorsUltraschall Med eFirst
DOI: 10.1055/a-1978-5690

 

  • References

  • 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2018; 68: 394-424
    CrossrefPubMedGoogle Scholar
  • 2 Marrero JA, Kulik LM, Sirlin CB. et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2018; 68: 723-750
    CrossrefPubMedGoogle Scholar
  • 3 Bridgewater J, Galle PR, Khan SA. et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014; 60: 1268-1289
    CrossrefPubMedGoogle Scholar
  • 4 Omata M, Cheng AL, Kokudo N. et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatology international 2017; 11: 317-370
    CrossrefPubMedGoogle Scholar
  • 5 Liu GJ, Wang W, Lu MD. et al. Contrast-Enhanced Ultrasound for the Characterization of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. Liver cancer 2015; 4: 241-252
    CrossrefPubMedGoogle Scholar
  • 6 Wildner D, Bernatik T, Greis C. et al. CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients – early or late washout matters: a subanalysis of the DEGUM multicenter trial. Ultraschall in Med 2015; 36: 132-139
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Kudo M, Matsui O, Izumi N. et al. Surveillance and diagnostic algorithm for hepatocellular carcinoma proposed by the Liver Cancer Study Group of Japan: 2014 update. Oncology 2014; 87 (Suppl. 01) 7-21
    CrossrefPubMedGoogle Scholar
  • 8 Zhou J, Sun HC, Wang Z. et al. Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition). Liver cancer 2018; 7: 235-260
    CrossrefPubMedGoogle Scholar
  • 9 ACR American College of Radiology. Liver Imaging Reporting and Data System. https://www.acr.org/Quality-Safety/Resources/LIRADS . Accessed 12 Sep 2017
    PubMedGoogle Scholar
  • 10 Terzi E, Iavarone M, Pompili M. et al. Contrast enhanced ultrasound identifies hepatocellular carcinoma in cirrhosis: a large multicenter retrospective study. J Hepatol 2017; 10: 32428-32425
    PubMedGoogle Scholar
  • 11 EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69: 182-236
    CrossrefPubMedGoogle Scholar
  • 12 Ling W, Wang M, Ma X. et al. The preliminary application of liver imaging reporting and data system (LI-RADS) with contrast-enhanced ultrasound (CEUS) on small hepatic nodules (</= 2cm). Journal of Cancer 2018; 9: 2946-2952
    CrossrefPubMedGoogle Scholar
  • 13 Schellhaas B, Gortz RS, Pfeifer L. et al. Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of hepatocellular carcinoma: ESCULAP versus CEUS-LI-RADS. Eur J Gastroenterol Hepatol 2017; 29: 1036-1044
    CrossrefPubMedGoogle Scholar
  • 14 Han J, Liu Y, Han F. et al. The Degree of Contrast Washout on Contrast-Enhanced Ultrasound in Distinguishing Intrahepatic Cholangiocarcinoma from Hepatocellular Carcinoma. Ultrasound in medicine & biology 2015; 41: 3088-3095
    CrossrefPubMedGoogle Scholar
  • 15 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
    CrossrefPubMedGoogle Scholar
  • 16 Li J, Ling W, Chen S. et al. The interreader agreement and validation of contrast-enhanced ultrasound liver imaging reporting and data system. Eur J Radiol 2019; 120: 108685
    CrossrefPubMedGoogle Scholar
  • 17 Zheng W, Li Q. Evaluation of Contrast-enhanced US LI-RADS version 2017: Application on 2020 Liver Nodules in Patients with Hepatitis B Infection. 2019; DOI: 10.1148/radiol.2019190878.
    CrossrefPubMedGoogle Scholar
  • 18 Schellhaas B, Hammon M, Strobel D. et al. Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS. Eur Radiol 2018; 28: 4254-4264
    CrossrefPubMedGoogle Scholar