ParticipantsAndrej Lyshchik, MD, PhD, Philadelphia, PA (Presenter) Research support, Bracco Group; Advisory Board, Bracco Group; Research support, General Electric Company; Research support, Siemens AG; Research support, Canon Medical Systems Corporation; Speaker, SonoScape Co, Ltd
Yuko Kono, MD, PhD, San Diego, CA (Abstract Co-Author) Equipment support, Canon Medical Systems Corporation Equipment support, General Electric Company Contrast agent support, Lantheus Medical Imaging, Inc Contrast agent support, Bracco Group
Fabio Piscaglia, Bologna, Italy (Abstract Co-Author) Research support, Esaote SpA; Speaker, Bayer AG; Speaker, Bracco Group; Speaker, Bristol-Myers Squibb Company; Speaker, Eisai Co, Ltd; Advisory Board, AstraZeneca PLC; Advisory Board, Bayer AG; Advisory Board, Eisai Co, Ltd; Advisory Board, General Electric Company; Advisory Board, Siemens AG; Advisory Board, Tiziana Life Sciences;
Shuchi K. Rodgers, MD, Philadelphia, PA (Abstract Co-Author) Nothing to Disclose
Geoffrey E. Wile, MD, Nashville, TN (Abstract Co-Author) Nothing to Disclose
Aya Kamaya, MD, Stanford, CA (Abstract Co-Author) Royalties, Reed Elsevier;
Alexandra Medellin, MD, Calgary, AB (Abstract Co-Author) Nothing to Disclose
Lisa Finch, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Stephanie R. Wilson, MD, Calgary, AB (Abstract Co-Author) Equipment support, Koninklijke Philips NV; Equipment support, Siemens AG; Equipment support, Samsung Electronics Co, Ltd; Research support, LANDAUER, Inc; Research support, Samsung Electronics Co, Ltd; Speakers Bureau, Koninklijke Philips NV
The American College of Radiology Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) is developed to classify focal liver observations in patients at risk of HCC. The aim of this prospective multicenter study is to validate the CEUS LI-RADS.
METHOD AND MATERIALSA total of 273 nodules from 255 patients at risk of HCC are included in this ongoing study conducted at 8 centers (6 in the USA, 1 in Canada and 1 in Italy). Focal liver observations are classified as LR-5, (definitely HCC) if greater than 1 cm with arterial phase hyperenhancement, and late, mild washout. Rim enhancement and/or early washout and/or marked washout qualify as LR-M (malignant, but not specific for HCC). Other observations are classified as definitely benign (LR-1); probably benign (LR-2), intermediate malignancy probability (LR-3); probably HCC (LR-4). Tumor-in-Vein is characterized as LR-TIV. Definite HCC diagnosis on MRI, imaging follow-up or histology for MRI-indeterminate observations were used as reference standard.
RESULTSThe median focal liver observation size is 2.4cm. Of 273 nodules, 162 (59%) have confirmed diagnosis while 111 (41%) nodules remain indeterminate, currently undergoing imaging surveillance or awaiting histological confirmation. Of 162 confirmed nodules, 136 are HCC (82%), 6 (4%) other malignancies (2 ICC, 1 combined hepatocellular-cholangiocarcinoma, 3 metastasis) and 22 (14%) are benign. A total of 84 confirmed observations are characterized as LR-5 and 100% of them are HCC. The sensitivity of LR-5 for HCC is 63%. All 14 LR-1 and LR-2 observations are benign. All 11 LR-M observations are malignant (5 HCC, 4 metastasis, 2 ICC). 67% (14/21) of LR-3 observations and 92% (24/26) of LR-4 observations are HCC. 5% of nodules are not characterized on CEUS (LR-NC)
CONCLUSIONThe CEUS LR-5 classification is 100% specific for HCC, confirming high clinical value of CEUS for noninvasive HCC diagnosis.
CLINICAL RELEVANCE/APPLICATIONContrast-enhanced ultrasound is a reliable method of focal liver observations classification in patients at risk for HCC