Arterial-Washout Temporal Profiling in CEUS LI-RADS: A Diagnostic Algorithm for Reducing Hepatocellular Carcinoma...

Area of Science:

• Radiology and Medical Imaging
• Diagnostic Ultrasound
• Hepatobiliary Imaging

Background:

• Contrast-enhanced ultrasound (CEUS) is crucial for liver lesion characterization.
• The Liver Imaging Reporting and Data System (LI-RADS) uses washout characteristics for classification.
• Misclassification of hepatocellular carcinoma (HCC) as LR-M remains a challenge.

Purpose of the Study:

• To evaluate if combining arterial phase onset time to washout onset time interval (AWTI) with washout onset time improves CEUS LI-RADS accuracy.
• To assess if this combined metric reduces misclassification of HCC as LR-M.
• To compare the diagnostic performance of the revised classification against standard LI-RADS.

Main Methods:

• Retrospective analysis of CEUS and clinical data from 352 patients with focal liver lesions (FLLs).
• Calculation of AWTI for FLLs with washout < 60 seconds.
• Proposal of a revised classification using washout and AWTI cutoffs (washout < 45s + AWTI < 21s for LR-M; washout ≥ 45s + AWTI ≥ 21s for LR-5).

Main Results:

• The revised LR-M classification significantly increased positive predictive value to 92.6%.
• The revised LR-5 classification significantly improved sensitivity (89.0%) and negative predictive value (87.0%).
• Overall diagnostic accuracy was 88.4% with an AUC of 0.88.

Conclusions:

• Combining washout onset time with AWTI enhances CEUS LI-RADS performance.
• This revised approach significantly reduces HCC misclassification.
• The new method offers improved diagnostic accuracy for LR-M and LR-5 categories.