Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules

Maurizio Pompili, Maria Assunta Zocco, Gian Ludovico Rapaccini, Laura Riccardi, Vincenza Salvatore, Maria Elena Ainora, Eleonora Terzi, Massimo Iavarone, Letizia Veronese, Giuseppe Cabibbo, Mirella Fraquelli, Ludovico De Bonis, Angelo Sangiovanni, Simona Leoni, Sandro Rossi, Nicola Alessi, Stephanie R. Wilson, Fabio Piscaglia, Alessandro Granito, Veronica SalvatoreFrancesco Tovoli, Matteo Angelo Manini, Valentina Ravetta, Agostino Ventra, Giuseppe Mogavero

Risultato della ricerca: Contributo in rivistaArticolo in rivista

79 Citazioni (Scopus)

Abstract

Background & Aims: The use of contrast enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC) in cirrhosis was questioned because of the risk of a false positive diagnosis in cases of cholangiocarcinoma. The American College of Radiology has recently released a scheme (CEUS Liver Imaging Reporting and Data System [LI-RADS®]) to classify lesions at risk of HCC investigated by CEUS. The aim of the present study was to validate this LI-RADS scheme for the diagnosis of HCC. Methods: A total of 1,006 nodules from 848 patients with chronic liver disease at risk of HCC were collected in five Italian centers and retrospectively analyzed. Nodules were classified as LR-5, (HCC) if ≥1 cm with arterial phase hyperenhancement, and late washout (onset ≥60 s after contrast injection) of mild degree. Rim enhancement and/or early and/or marked washout qualified lesions as LR-M (malignant, but not specific for HCC). Other combinations qualified lesions at intermediate risk for HCC (LR-3) or probable HCC (LR-4). Diagnostic reference standard was CT/MRI diagnosis of HCC (n = 506) or histology (n = 500). Results: The median nodule size was 2 cm. Of 1,006 nodules, 820 (81%) were HCC, 40 (4%) were cholangiocarcinoma, 116 (11%) regenerative nodules (±dysplastic). The LR-5 category (52% of all nodules) was 98.5% predictive of HCC, with no risk of misdiagnosis for pure cholangiocarcinoma. Sensitivity for HCC was 62%. All LR-M nodules were malignant and the majority of non-hepatocellular origin. Over 75% of cholangiocarcinomas were LR-M. The LR-3 category included 203 lesions (HCC 96 [47%]) and the LR-4 202 (HCC 173 [87%]). Conclusions: The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. Lay summary: This is a retrospective study of approximately 1,000 focal lesions at risk for hepatocellular carcinoma (HCC). Herein, we demonstrate that the refined definition of the typical contrast enhanced ultrasound pattern of HCC introduced by the Liver Imaging Reporting and Data System (LI-RADS®) practically abolishes the risk of misdiagnosis of other malignant entities (e.g. cholangiocarcinoma) for HCC with negligible reduction in sensitivity. These data support the use of contrast enhanced ultrasound to diagnose HCC in cirrhosis.
Lingua originaleEnglish
pagine (da-a)485-492
Numero di pagine8
RivistaJournal of Hepatology
Volume68
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Adult
  • Aged
  • Algorithms
  • Arterial hyperenhancement
  • Carcinoma, Hepatocellular
  • Cholangiocarcinoma
  • Contrast Media
  • Contrast enhanced ultrasound
  • Diagnosis, Differential
  • Diagnostic Errors
  • Female
  • Humans
  • Image Enhancement
  • Liver
  • Liver Cirrhosis
  • Liver Imaging Reporting And Data System (LI-RADS)
  • Liver Neoplasms
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Tomography, X-Ray Computed
  • Ultrasonography
  • Washout

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