Response to 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 Collaborators

Thanks Stefanini and your colleagues for positive comments on our recent study of applying CEUS LI-RADS in eastern countries with emphasis on diagnostic performance and interobserver agreement [1]. We agree that the specificity of CEUS LR-5 is high enough (range:92.7–100.0 % in cirrhotic patients in our study) to rule out non-hepatocellular carcinoma(HCC) lesions. And we also agree that inconsistency of interpreting objective CEUS features, especially ancillary features, significantly hinder the general application of CEUS LI-RADS in targeted high-risk population. Even after years of CEUS LI-RADS learning and training, ancillary features are still deemed as failure to make additional value in final decision. Therefore, we fully approve removing current ancillary features (mosaic and nodule-in-nodule pattern) from CEUS LI-RADS workup as Stefanini demonstrated.

Publication History

Article published online:
19 April 2023

• References

• 1 Zhou H, Zhang C, Du L. et al. Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Diagnosing Hepatocellular Carcinoma: Diagnostic Performance and Interobserver Agreement. Ultraschall in der Medizin (Stuttgart, Germany: 1980) 2022; 43: 64-71
• 2 Ding J, Long L, Zhang X. et al. Contrast-enhanced ultrasound LI-RADS 2017: comparison with CT/MRI LI-RADS. European radiology 2021; 31: 847-854
• 3 Huang JY, Li JW, Lu Q. et al. Diagnostic Accuracy of CEUS LI-RADS for the Characterization of Liver Nodules 20 mm or Smaller in Patients at Risk for Hepatocellular Carcinoma. Radiology 2020; 294: 329-339
• 4 Shin J, Lee S, Hwang JA. et al. MRI-diagnosis of category LR-M observations in the Liver Imaging Reporting and Data System v2018: a systematic review and meta-analysis. European radiology 2022; 32: 3319-3326
• 5 Zhou H, Sun J, Jiang T. et al. A Nomogram Based on Combining Clinical Features and Contrast Enhanced Ultrasound LI-RADS Improves Prediction of Microvascular Invasion in Hepatocellular Carcinoma. Frontiers in oncology 2021; 11: 699290
• 6 Ding J, Qin Z, Zhou Y. et al. Impact of Revision of the LR-M Criteria on the Diagnostic Performance of Contrast-Enhanced Ultrasound LI-RADS. Ultrasound in medicine & biology 2021; 47: 3403-3410
• 7 Li CQ, Huang H, Ruan SM. et al. An assessment of liver lesions using a combination of CEUS LI-RADS and AFP. Abdominal radiology (New York) 2022; 47: 1311-1320
• 8 Feng Y, Qin XC, Luo Y. et al. Efficacy of contrast-enhanced ultrasound washout rate in predicting hepatocellular carcinoma differentiation. Ultrasound in medicine & biology 2015; 41: 1553-1560