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Background &amp; aims <p>Timely and accurate diagnosis of hepatocellular carcinoma (HCC) is essential for improving patient outcomes and guiding treatment. This multicenter study aimed to optimize the diagnostic workflow for HCC through a step-wise combination of CT/MRI and contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS).</p> Methods <p>This was a multicenter, retrospective analysis of prospectively recruited high-risk HCC participants with liver observations from 4 institutions, between January 2017 and December 2021. These participants initially underwent CT/MRI followed by CEUS, with observations categorized according to CT/MRI/CEUS LI-RADS. Three step-wise diagnostic strategies were evaluated, starting with CT/MRI and followed by CEUS, and compared to CT/MRI LI-RADS alone. Performance metrics included AUC, accuracy, sensitivity, specificity, PPV, and NPV, using pathology or over one year of follow-up as standards. The impact on clinical decisions was measured by false-negative, false-positive, and biopsy rates.</p> Results <p>Of 1264 participants, 874 (69%) were confirmed as HCC. The step-wise strategies outperformed CT/MRI LI-RADS. Strategy-3, which involved subsequent CEUS for CT/MRI LR-3/4 observations, significantly improved sensitivity (88.8% vs. 79.9%,<i> P</i> &lt; 0.001) while maintaining comparable specificity (88.2% vs. 91.3%, <i>P</i> &gt; 0.05). Strategy-3 reduced biopsy rate (31.5–22.4%, <i>P</i> = 0.028) and decreased false-negative rate (20.1–11.2%, <i>P</i> &lt; 0.001). Additionally, 96% (55/57) of CT/MRI LR-3 and 97% (77/79) of CT/MRI LR-4 observations were accurately diagnosed and treated as HCC, with 61% (74/121) of CT/MRI LR-4 observations avoiding biopsy with CEUS-assisted.</p> Conclusion <p>A step-wise approach using CT/MRI followed by CEUS for LR-3/4 observations improved the diagnostic performance and further refined clinical decision-making in HCC.</p> Trial registration <p>Clinical Trial Registration Number: ChiCTR-DDD-16010089.</p>

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The role of contrast-enhanced ultrasound in the radiological classification of liver observations identified by CT and MRI

  • 期刊论文

  • 发表日期：

    2025年3月24日

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  • Hui Huang,
  • Dan-Ni He,
  • Rui-Fang Lu,
  • Wen-Juan Tong,
  • Ying Wang,
  • Si Qin,
  • Rong Wen,
  • Shao-Hong Wu,
  • Si-Min Ruan,
  • Guang-Jian Liu,
  • Ming-De Lu,
  • Ming Kuang,
  • Wei Wang,
  • Mei-Qing Cheng,
  • Hong Yang,
  • Li-Da Chen

摘要

Background & aims

Timely and accurate diagnosis of hepatocellular carcinoma (HCC) is essential for improving patient outcomes and guiding treatment. This multicenter study aimed to optimize the diagnostic workflow for HCC through a step-wise combination of CT/MRI and contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS).

Methods

This was a multicenter, retrospective analysis of prospectively recruited high-risk HCC participants with liver observations from 4 institutions, between January 2017 and December 2021. These participants initially underwent CT/MRI followed by CEUS, with observations categorized according to CT/MRI/CEUS LI-RADS. Three step-wise diagnostic strategies were evaluated, starting with CT/MRI and followed by CEUS, and compared to CT/MRI LI-RADS alone. Performance metrics included AUC, accuracy, sensitivity, specificity, PPV, and NPV, using pathology or over one year of follow-up as standards. The impact on clinical decisions was measured by false-negative, false-positive, and biopsy rates.

Results

Of 1264 participants, 874 (69%) were confirmed as HCC. The step-wise strategies outperformed CT/MRI LI-RADS. Strategy-3, which involved subsequent CEUS for CT/MRI LR-3/4 observations, significantly improved sensitivity (88.8% vs. 79.9%, P < 0.001) while maintaining comparable specificity (88.2% vs. 91.3%, P > 0.05). Strategy-3 reduced biopsy rate (31.5–22.4%, P = 0.028) and decreased false-negative rate (20.1–11.2%, P < 0.001). Additionally, 96% (55/57) of CT/MRI LR-3 and 97% (77/79) of CT/MRI LR-4 observations were accurately diagnosed and treated as HCC, with 61% (74/121) of CT/MRI LR-4 observations avoiding biopsy with CEUS-assisted.

Conclusion

A step-wise approach using CT/MRI followed by CEUS for LR-3/4 observations improved the diagnostic performance and further refined clinical decision-making in HCC.

Trial registration

Clinical Trial Registration Number: ChiCTR-DDD-16010089.