A Multicenter Study Based On Contrast-enhanced Ultrasound Liver Imaging Reporting And Data System

Part ? Accuracy and consistency of contrast enhanced ultrasound Liver Imaging Reporting and Data System in diagnosing hepatocellular carcinomaObjective: To evaluate the accuracy and consistency of contrast enhanced ultrasound Liver Imaging Reporting and Data System(CEUS LI-RADS)in diagnosing hepatocellular carcinoma(HCC).Methods: Imaging and clinical data of 399 patients with 526 focal liver lesions who underwent contrast enhanced ultrasound(CEUS)were collected retrospectively.Two trained radiologists reviewed all CEUS clips independently.Patients' clinical data and imaging diagnosis results were blinded to reviewers.Each radiologist provided CEUS LI-RADS category for each observation independently according to the contrast enhancement patterns.The diagnostic performances of CEUS LI-RADS were evaluated by accuracy,sensitivity,specificity,positive predictive value,and negative predictive value.And the consistency between reviewers was analyzed by ? test.Results: ?=0.779(P=0.021)indicated that CEUS LI-RADS algorithm made substantial consistency between reviewers.For the diagnosis of HCC using LR-5 category,the accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 85.17% [95% confidence interval [CI]:(81.88%,87.95%)],78.32% [95% CI:(72.50%,83.19%)],90.33% [95% CI:(86.46%,93.19%)],85.92% [95% CI:(80.51%,90.02%)],84.69% [95% CI:(80.33%,88.22%)],respectively.For the diagnosis of malignant using LR-5 and LR-M categories,the accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 89.35% [95% CI:(86.43%,91.71%)],81.47% [95% CI:(76.29%,85.73%)],97.00% [95% CI:(94.20%,98.47%)],96.35% [95% CI:(92.96%,98.14%)],84.36% [95% CI:(79.88%,88.00%)],respectively.Conclusions: CEUS LI-RADS algorithm can not only have excellent efficacy in diagnosing HCC,but also showed substantial consistency among radiologists.As a comprehensive algorithm,CEUS LI-RADS can act as an important tool to differential diagnosis for focal liver lesions,and we look forward to its application in the future clinical work.Part ? Optimization of contrast enhanced ultrasound Liver Imaging Reporting and Data System in diagnosing hepatocellular carcinomaObjective: To compare the diagnostic efficacy of contrast enhanced ultrasound Liver Imaging Reporting and Data System(CEUS LI-RADS)with CEUS LI-RADS-U in diagnosing hepatocellular carcinoma(HCC).Methods: Imaging and clinical data of 329 patients with 381 focal liver lesions who underwent contrast enhanced ultrasound(CEUS)were collected retrospectively.Two trained radiologists reviewed all CEUS clips independently.Patients' clinical data and imaging diagnosis results were blinded to reviewers.Each radiologist provided CEUS LI-RADS and CEUS LI-RADS-U category for each observation independently according to the contrast enhancement patterns.The diagnostic efficacy of the above two methods were evaluated by accuracy,sensitivity,specificity,positive predictive value,and negative predictive value.Results: Two malignant hepatic nodules categorized as LR-3 in CEUS LI-RADS were upgraded to LR-4 in CEUS LI-RADS-U.A total of 24 hepatic nodules categorized as LR-4 in CEUS LI-RADS were upgraded to LR-5 in CEUS LI-RADS-U.One HCC nodules categorized as LR-M in CEUS LI-RADS were regraded to LR-5 in CEUS LI-RADS-U.Sensitivities of LR-5 category for diagnosing HCC in CEUS LI-RADS-U were higher than that in CEUS LI-RADS(84.96% vs 78.32%,P=0.068;84.43% vs 75.45%,P = 0.040),with no significant loss of specificities(74.84% vs 81.29%,P=0.170;60.42% vs 70.84%,P = 0.129).The accuracy of the above two methods in diagnosing HCC was very close(80.84% vs 79.53%,P=0.650;75.67% vs 73.76%,P = 0.616).Conclusions: These findings suggest that CEUS LI-RADS-U showed higher sensitivity with no significant loss of specificity compared with CEUS LI-RADS for the diagnosis of HCC using LR-5.And the diagnostic accuracy of the above two methods in diagnosing HCC was very close.At present,CEUS LI-RADS still has the possibility of further optimization,which can be improved mainly from three aspects: arterial phase hyperenhancement,washout and nodule size.Part ? Comparison of contrast enhanced ultrasound versus contrast enhanced magnetic resonance imaging for the diagnosis of focal liver lesions using Liver Imaging Reporting and Data SystemObjective: To evaluate the Liver Imaging Reporting and Data System(LI-RADS)categorization of focal liver lesions(FLLs)on contrast enhanced ultrasound(CEUS)in comparison with contrast enhanced magnetic resonance imaging(CEMRI).Methods: A total of 164 patients with 206 FLLs were included in the final study population,after review of the electronic medical records and clinical data.Two trained radiologists evaluated all CEUS and CEMRI images independently.Patients' clinical data and imaging diagnosis results were blinded to reviewers.They assigned LI-RADS categories for each FLLs based on CEUS LI-RADS version 2017 and CT/MRI LI-RADS version 2018.Both major features and ancillary features of FLLs were assessed in the meanwhile.LI-RADS categories were compared between imaging examination methods,and the consistency between reviewers was evaluated.Results: Sensitivities of LR-5 category for diagnosing hepatocellular carcinoma(HCC)were significantly different between CEUS and CEMRI(83.18% vs.60.75%,P<0.01;76.64% vs.61.68%,P=0.015).Interobserver agreement was excellent for assigning LR-5 category both on CEUS and CEMRI(?=0.864,?=0.852).For both reviewers,a higher frequency of LR-5 was observed in CEUS compared with CEMRI.And for reviewer 2,the arterial phase hyperenhancement(APHE)phenomenon was less frequently demonstrated on CEUS than on CEMRI.However,both reviewers observed that the washout appearance was demonstrated more frequently on CEUS than on CEMRI(52.4% vs.38.3%,P = 0.004;53.9% vs 41.7%,P = 0.014).The interobserver agreement for APHE and washout appearance between two reviewers was excellent for both CEUS and CEMRI.Conclusions: These findings suggest that CEUS showed higher sensitivity to CEMRI for the diagnosis of HCC using LI-RADS,and although frequencies of major features were different,interobserver agreement for HCC major features between two reviewers was excellent for both CEUS and CEMRI.