| Objective:To compare the value of contrast-enhanced ultrasound(CEUS)Liver Imaging Reporting and Data System(LI-RADS)version 2017 with contrast-enhanced computerized tomography and magnetic resonance imaging(CECT/MRI)LI-RADS version 2017 in diagnosing hepatocellular carcinoma(HCC)in patients at high risk and differentiating hepatocellular carcinomas(HCC)from non-HCC hepatic malignancies.Patients and methods:Four hundred ninety-two patients at high risk of HCC risk underwent(CEUS)and CECT or gadoxetic acid-enhanced MRI(EOB-MRI)examinations.Two hundred thirty-nine patients with 273 nodules were enrolled in this study.Surgical pathology or ultrasound-guided biopsy pathology was used for the diagnostic standard reference.Each nodule was assigned a specific category according to CEUS and CECT/EOB-MRI LI-RADS version 2017 in the absence of patient information,pathology and related clinical characteristics.The diagnostic performance of CEUS and CECT/EOB-MRI LI-RADS for HCC was analyzed and compared.Inter-modality agreement was assessed with Cochen’s kappa.Results:Of the 273 nodules,there were 225 hepatocellular carcinomas(HCCs),12 intrahepatic cholangiocarcinomas(ICCs),8 combined hepatocellular-cholangiocarcinomas(CHCs),2 metastases(M),and 26 benign nodules.The inter-modality agreement for the LI-RADS category between CEUS and CECT/EOB-MRI was fair(Kappa=0.319,P<0.001).Of the 273 nodules categorized by CEUS and CECT/EOB-MRI,the positive predictive value of LR-5,LR-4,and LR-3 category for HCC were 98.3%(95% CI: 94.6%,99.6%)vs 95.9%(95% CI:91.8%,98.1%),60.0%(95% CI: 38.9%,78.1%)vs 65.7%(95% CI: 47.7%,80.3%),25.0%(95% CI: 0.8%,52.6%)vs 48.1%(95% CI: 29.2%,67.6%)respectively;the LR-5 sensitivity and specificity for diagnosing HCC between CEUS and CECT/EOB-MRI groups were 75.6%(95% CI: 69.3%,81.0%)vs 83.6%(95% CI:77.9%,88.0%)and 93.8%(95% CI: 81.8%,98.4%)vs 83.3%(95% CI: 69.2%,92.0%).The positive predictive value of LR-M category between CEUS and CECT/EOB-MRI for non-HCC hepatic malignancies were 33.9%(95% CI: 22.4%,47.5%)vs 93.3%(95% CI: 66.0%,99.7%),respectively(P=0.000);The sensitivity,specificity and accuracy for diagnosing non-HCC hepatic malignancies were 90.9%(95% CI: 69.4%,98.4%)vs 63.6%(95% CI: 40.8%,82.0%),84.5%(95% CI: 79.2%,88.6%)vs 99.6%(95% CI: 97.4%,99.9%),85.0%(95% CI: 80.1%,88.9%)vs 96.7%(95% CI: 93.6%,98.4%).Conclusions:The inter-modality agreement for the LI-RADS category between CEUS and CECT/EOB-MRI is fair.The predictive value of CEUS LR-5 category for the presence of HCC is similar and excellent to that of CECT/EOB-MRI for patients with at the high risk of HCC.CECT/EOB-MRI LR-M category is superior to CEUS in predictive value for non-HCC hepatic malignancies.However,the LR-M of CEUS LI-RADS in the differential diagnosis of non-HCC hepatic malignancies and HCC remains to be further studied. |
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