Incorporating new criteria can improve the ability of CEUS LI-RADS to differentiate HCC from non-HCC malignancies

Area of Science:

• Hepatobiliary imaging
• Diagnostic radiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) diagnosis relies on imaging.
• Contrast-enhanced ultrasound (CEUS) with LI-RADS criteria is crucial for HCC risk stratification.
• Distinguishing HCC from other malignant liver lesions can be challenging.

Purpose of the Study:

• To evaluate the diagnostic performance of CEUS LI-RADS.
• To enhance the differentiation between HCC and non-HCC malignancies by modifying LR-M criteria.

Main Methods:

• Retrospective analysis of CEUS examinations in high-risk HCC patients.
• Reassessment of LR-M lesions using modified criteria, focusing on early washout timing.
• Comparison of diagnostic efficacy across four distinct early washout criteria.

Main Results:

• Modified criteria, particularly 'washout onset-enhancement onset < 30 s' (Criterion 4), showed improved sensitivity for HCC detection compared to earlier criteria.
• Specificities and positive predictive values (PPVs) remained high across most modified criteria, with Criterion 1 showing the highest specificity.
• Criterion 2 demonstrated higher sensitivity but significantly lower specificity and PPV.

Conclusions:

• The proposed new criterion for early washout (washout onset-enhancement onset < 30 s) shows promise for improving HCC differentiation.
• Refining CEUS LI-RADS criteria can enhance diagnostic accuracy in distinguishing HCC from non-HCC malignancies.
• Further validation of modified LR-M criteria is warranted for clinical application.