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LI-RADS for diagnosing hepatocellular carcinoma by contrast-enhanced US with SonoVue and Sonazoid-a single center
Chen Lin1, Xiao-Huan Yang2, Hong-Yan Zhai1
1Tianjin Medical University General Hospital, Tianjin, China.
Insights
A modified algorithm using Sonazoid contrast-enhanced ultrasound (CEUS) with Kupffer-phase imaging significantly improved hepatocellular carcinoma (HCC) detection sensitivity compared to standard SonoVue CEUS LI-RADS. This enhanced HCC diagnostic performance was achieved without compromising specificity.
Area of Science:
- Hepatobiliary imaging
- Diagnostic performance evaluation
- Hepatocellular carcinoma (HCC) detection
Background:
- Contrast-enhanced ultrasound (CEUS) is crucial for diagnosing hepatocellular carcinoma (HCC).
- Current LI-RADS (Liver Imaging Reporting and Data System) guidelines have limitations in HCC diagnosis.
- Sonazoid CEUS offers unique Kupffer-phase imaging, potentially improving diagnostic accuracy.
Purpose of the Study:
- To compare the diagnostic performance of two CEUS algorithms for HCC.
- Evaluate SonoVue-CEUS LI-RADS (version 2017) against a modified Sonazoid-CEUS algorithm incorporating Kupffer-phase findings.
Main Methods:
- Prospective, single-center study of high-risk HCC patients.
- Patients underwent both SonoVue-CEUS and Sonazoid-CEUS.
- Liver observations were categorized using both standard and modified LI-RADS algorithms, with pathologic confirmation as the reference standard.
Main Results:
- The modified Sonazoid-CEUS LI-RADS demonstrated significantly higher sensitivity (82% vs. 65%) and accuracy (85% vs. 71%) compared to SonoVue-CEUS LI-RADS.
- No significant difference in specificity was observed between the two methods (93% vs. 87%).
- The modified algorithm upgraded observations based on Kupffer-phase defect characteristics.
Conclusions:
- Incorporating Kupffer-phase findings in Sonazoid-CEUS LI-RADS enhances HCC diagnostic sensitivity.
- This modified approach achieves higher sensitivity without a reduction in specificity.
- Sonazoid-CEUS with Kupffer-phase analysis offers improved diagnostic capabilities for HCC.
Purpose:
To compare the diagnostic performance of two algorithms for HCC diagnosis: SonoVue-CEUS based on CEUS LI-RADS version 2017 and a modified algorithm incorporating Kupffer-phase findings for Sonazoid-CEUS.
Methods:
This single center prospective study enrolled high-risk patients for HCC. Each participant underwent SonoVue-CEUS and Sonazoid-CEUS. Each liver observation was assigned two LI-RADS categories according to each algorithm: SonoVue-CEUS LI-RADS and modified Sonazoid-CEUS LI-RADS. For the latter method, observations at least 10 mm with non-rim arterial phase hyperenhancement were upgraded LR-4 to LR-5 if there was no washout with a Kupffer defect and were reassigned LR-M to LR-5 if there was early washout with mild Kupffer defect. The reference standard was pathologic confirmation.
Results:
Overall, 66 patients (mean age, 61.2 years ± 10.9; 54 male patients, 12 female patients) with 66 observations (mean size, 31 mm ± 16) were eventually enrolled. The results of Sonazoid-CEUS LI-RADS showed significant changes in sensitivity (82% vs. 65%, p < 0.001), accuracy (85% vs. 71%, p < 0.001) compared with the SonoVue-CEUS LI-RADS. There was no significant difference in specificity (93% vs. 87%, p = 0.26).
Conclusion:
When incorporating Kupffer-phase findings, Sonazoid-CEUS LI-RADS had higher sensitivity without loss of specificity compared with SonoVue-CEUS LI-RADS.
