The Diagnostic Value Of LI-RADS Of Contrast-enhanced Ultrasound In Small Hepatocellular Carcinoma

Objective : The purpose of this study was to explore the clinical value of the Liver Imaging Report and Data System(LI—RADS)with contrast enhanced ultrasound(CEUS)in the diagnosis of small hepatocellular carcinoma.Methods:From January 2008 to December 2019,129 patients with focal liver lesions were selected and all the lesions diagnosed by histopathology.The lesions were classified according to the CEUS LI—RADS classification standard to judge the diagnostic efficiency of the CEUS LI—RADS classification.Results : The average size of the lesions was 2.2 ± 0.5 cm in 129 lesions from 120 patients.Among the 129 lesions with HCC high-risk factors,postoperative pathological results showed 112 lesions of hepatocellular carcinoma(HCC),9 lesions of non-HCC malignant tumors,and 8 lesions of benign lesions.According to CEUS LI—RADS classification,there were 6 lesions(4.6%)of LR-3,17 lesions(13.2%)of LR-4,73lesions(56.5%)of LR-5 and 34 lesions(25.6%)of LR-M.The positive predictive values of LR-3 class,LR-4 class,LR-5 class and LRM class for diagnosing HCC were 16.7%(1/6)、88.2%(15/17)、98.6%(72/73)、72.7%(24/33).The diagnosis of hepatocellular carcinoma(HCC)with LR-4 +LR-5 was compared with that with LR-5.The sensitivity increased from 64.3% to 77.7%.The difference was statistically significant(P<0.05).The specificity decreased from 94.1% to 82.4%,with no statistically significant difference(P=0.601).The positive predictive value and negative predictive value ranged from 98.6% to 96.7% and 27.3% to 35.9% respectively,and the difference was not statistically significant(P=0.629,P=0.450).The early washout time of LR-M was changed from 1 min to 40 s.The sensitivity of LR-4+LR-5 to diagnose HCC was increased from 77.7% to 92%,with statistically significant differences(P<0.05).The specificity decreased from 82.4% to 64.7%,with no statistically significant difference.The specificity decreased from 82.4% to 64.7%,the positive predictive value decreased from 96.7% to 94.5%,and the negative predictive value increased from 35.9% to 55%,but the difference was not statistically significant(P=0.438,P=0.516,P=0.160).Most of the HCC in the LR-5 were moderately and well differentiated,while were moderately and poorly differentiated in the LR-M.There was a difference in the degree of differentiation between LR-M and LR-5 in the degree of HCC differentiation(P<0.05).Conclusion:There was high diagnostic value in the diagnosis of small hepatocellular carcinoma with CEUS LI-RADS classification.LR-5 has high accuracy in the diagnosis of HCC.The poorly differentiated HCC in LR-M accounted for a large proportion.It played an important role that early washout time was setted in the differential diagnosis of LR-M and LR-5.