LI-RADS-CEUS – Proposal for a Contrast-Enhanced Ultrasound Algorithm for the Diagnosis of Hepatocellular Carcinoma in High-Risk Populations

Abstract

Purpose: To develop a contrast-enhanced ultrasound algorithm (LI-RADS-CEUS = liver imaging reporting and data system with contrast-enhanced ultrasound) for the diagnosis of hepatocellular carcinoma (HCC) in patients at risk.

Materials and Methods: A CEUS algorithm (LI-RADS-CEUS) was designed analogously to CT- and MRI-based LI-RADS. LI-RADS-CEUS was evaluated retrospectively in 50 patients at risk with confirmed HCC or non-HCC lesions (test group) with subsequent validation in a prospective cohort of 50 patients (validation group). Results were compared to histology, CE-CT and CE-MRI as reference standards.

Results: Tumor diagnosis in the test group/validation group (n = 50/50) were 46/41 HCCs, 3/3 intrahepatic cholangiocellular carcinomas (ICCs) and 1/6 benign lesions. The diagnostic accuracy of LI-RADS-CEUS for HCC, ICC and non-HCC-non-ICC-lesions was 89 %. For the diagnosis of HCC, the diagnostic accuracy was 93.5 % (43/46 cases) in the test group and 95.1 % (39/41 cases) in the validation group. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 %, 66.6 %, 94.3 % and 66.6 %, respectively (mean values from both cohorts). Histological findings of HCC were available in 40 versus 23 cases (in total: G1 / G2/G3: 15/35/13). Arterial hyperenhancement was seen in 68/87 (78.2 %) of HCCs. Arterial hyperenhancement with subsequent portal venous or late phase hypoenhancement was seen in 66 % of HCCs.

Conclusion: LI-RADS-CEUS offers a CEUS algorithm for standardized assessment and reporting of focal liver lesions in patients at risk for HCC. Arterial hyperenhancement in CEUS is the key feature for the diagnosis of HCC in patients at risk, whereas washout is not a necessary prerequisite.

Zusammenfassung

Ziel: Entwicklung eines standardisierten Kontrastmittel-Ultraschall-(CEUS-)basierten Algorithmus (LI-RADS-CEUS) für die Diagnostik hepatozellulärer Karzinome (HCCs) bei Risikopatienten.

Material und Methoden: Ein CEUS-basierter Algorithmus (LI-RADS-CEUS) wurde analog zum CT- und MRT-basierten LI-RADS (Liver Imaging Reporting and Data System) entwickelt. LI-RADS-CEUS wurde retrospektiv an 50 Risikopatienten mit gesicherten HCC- oder Nicht-HCC-Läsionen getestet (Testgruppe) und anschließend prospektiv bei 50 Risikopatienten validiert (Validierungsgruppe). Als Referenz dienten Histologie, CT und MRT.

Ergebnisse: In beiden Patientenkohorten (n = 50/50) fanden sich 46/41 HCCs, 3/3 intrahepatische cholangiozelluläre Karzinome (ICCs) und 1/6 benigne Leberläsionen. Die diagnostische Genauigkeit von LI-RADS-CEUS für HCC, ICC und Nicht- HCC-/-ICC-Herde betrug insgesamt 89 %. Für HCCs war die diagnostische Genauigkeit in den Gruppen 93,5 % (43/46 HCCs)/95,1 % (39/41 HCCs). Sensitivität, Spezifität, PPW und NPW für HCCs betrugen 94,3 %/66,6 %/94,3 % und 66,6 % (Mittelwerte beider Patientenkohorten). Bei 40/23 HCCs lag eine Histologie vor (insgesamt: G1/G2/G3: 15/35/13). Arterielles Hyperenhancement fand sich bei 68/87 (78,2%) der HCCs. Arterielles Hyperenhancement mit anschließendem portalvenösem oder Spätphasen-Hypoenhancement fand sich bei 66% der HCCs.

Schlussfolgerung: LI-RADS-CEUS bietet einen CEUS-Algorithmus für die standardisierte Beurteilung und Dokumentation HCC-suspekter Läsionen bei Risikopatienten. Arterielles Hyperenhancement ist der wichtigste Parameter in CEUS für die Diagnose eines HCC; Washout ist keine zwingende Voraussetzung.

Key words

ultrasound - contrast agents - hepatocellular carcinoma - LI-RADS - liver

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