Contrast-Enhanced US Using Perfluorobutane for Diagnosing Small HCC in High-Risk Patients: Comparison with MRI...

Area of Science:

• Radiology
• Medical Imaging
• Hepatology

Background:

• Limited evidence exists for perfluorobutane (PFB) contrast-enhanced ultrasound (CEUS) within Liver Imaging Reporting and Data System (LI-RADS) for diagnosing small hepatocellular carcinoma (HCC) (≤20 mm) in high-risk individuals.
• This study addresses the gap by comparing PFB CEUS and MRI for small HCC detection.

Purpose of the Study:

• To compare the diagnostic performance of PFB CEUS and MRI in identifying small HCC (≤20 mm) in patients at high risk for HCC.
• To evaluate two distinct PFB CEUS strategies against MRI LI-RADS.

Main Methods:

• A multicenter retrospective study involving high-risk patients who underwent both PFB CEUS and MRI for liver nodules ≤20 mm.
• Two PFB CEUS strategies were defined: Strategy A (LR-5 criteria, CEUS LI-RADS v2017) and Strategy B (Strategy A plus Kupffer-phase hypoenhancement).
• Diagnostic performance was compared using a generalized estimating equations approach.

Main Results:

• Strategy B demonstrated higher sensitivity than Strategy A (65.9% vs 57.1%, P < .001) with similar specificity (91.8% vs 93.9%, P = .07).
• PFB CEUS Strategy B showed comparable sensitivity (65.9% vs 72.6%, P = .07) and specificity (91.8% vs 90.5%, P = .59) to MRI LI-RADS.
• Both CEUS strategies showed higher specificity in patients without cirrhosis compared to those with cirrhosis.

Conclusions:

• PFB CEUS, particularly when incorporating Kupffer-phase findings (Strategy B), is effective for diagnosing small HCC in high-risk patients.
• The diagnostic performance of this PFB CEUS approach is similar to that of MRI.
• This finding supports the potential incorporation of PFB CEUS into LI-RADS for small HCC diagnosis.