CEUS LI-RADS 2017
Objective:
CEUS LI-RADS 2017 is used in this study to assess its efficacy in diagnosing hepatocellular carcinoma (HCC) in high-risk patients, comparing its performance between nodules of different sizes. The study focuses on the diagnostic effectiveness of CEUS LI-RADS in identifying HCC in liver lesions, categorizing them based on their size (<20 mm vs. ≥20 mm). By analyzing the diagnostic accuracy, sensitivity, specificity, and positive predictive value (PPV) for each group, the study aims to determine how well CEUS LI-RADS performs in distinguishing malignant from benign liver lesions in these high-risk patients.
Methods:
The study included 601 patients with 545 untreated liver nodules. The researchers divided the patients into two groups based on nodule size: <20 mm (43 nodules) and ≥20 mm (502 nodules). The team performed CEUS on all nodules and classified the imaging results according to CEUS LI-RADS criteria. Histopathological findings, obtained through biopsy or surgical excision, served as the gold standard for diagnosis. The study excluded patients with tumor thrombus (LI-RADS TIV), previously treated lesions, or incomplete imaging data.
Results:
The diagnostic performance of CEUS LR-5 criteria showed no significant differences between the two groups in terms of accuracy, sensitivity, specificity, and positive predictive value (PPV) (all p > 0.05). However, the study found that the accuracy, sensitivity, and PPV of the LR5/M criteria for malignancy were significantly lower in the <20 mm group compared to the ≥20 mm group (p < 0.05). This suggests that while CEUS LI-RADS performs similarly for diagnosing HCC in both small and large lesions, its efficacy is higher for lesions ≥20 mm when identifying malignancies.
Imaging Features:
The study evaluated key imaging features, including arterial phase hyper-enhancement (APHE) and washout patterns. Smaller lesions showed a lower prevalence of APHE and delayed washout compared to larger nodules, which is consistent with findings from previous studies. These differences impact the sensitivity of CEUS for diagnosing HCC in smaller lesions.
Conclusion:
CEUS LI-RADS is a reliable diagnostic tool for HCC, especially for lesions ≥20 mm. The study highlights its utility in clinical decision-making for high-risk patients while pointing out the need for further refinement in diagnostic criteria to improve accuracy for smaller liver nodules.