Department of Medical and Surgical Sciences, Division of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
A.M. & A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy.
J Hepatol. 2018 Mar;68(3):485-492. doi: 10.1016/j.jhep.2017.11.007. Epub 2017 Nov 11.
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.
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).
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%]).
The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis.
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.
由于胆管细胞癌可能导致假阳性诊断，因此人们对使用对比增强超声（CEUS）诊断肝硬化肝细胞癌（HCC）提出了质疑。美国放射学院最近发布了一种方案（CEUS 肝脏成像报告和数据系统[LI-RADS®]），用于对 CEUS 检查的 HCC 高危病变进行分类。本研究旨在验证该 LI-RADS 方案对 HCC 的诊断价值。
在意大利的五个中心共收集了 848 例慢性肝病高危 HCC 患者的 1006 个结节，进行回顾性分析。如果结节≥1cm 且动脉期呈高增强，伴有轻度延迟洗脱（造影剂注射后 60s 开始），则将其归类为 LR-5（HCC）。边缘增强和/或早期和/或明显洗脱可将病变归类为 LR-M（恶性，但非 HCC 特异性）。其他组合则将病变归类为 HCC 中危（LR-3）或可能 HCC（LR-4）。诊断参考标准为 CT/MRI 诊断 HCC（n=506）或组织学诊断 HCC（n=500）。
结节的中位直径为 2cm。在 1006 个结节中，820 个（81%）为 HCC，40 个（4%）为胆管细胞癌，116 个（11%）为再生结节（伴/不伴异型增生）。LR-5 类别（占所有结节的 52%）对 HCC 的预测准确率为 98.5%，不存在误诊为单纯胆管细胞癌的风险。HCC 的敏感性为 62%。所有 LR-M 结节均为恶性，且大多数起源于非肝细胞。超过 75%的胆管细胞癌为 LR-M。LR-3 类别包括 203 个病变（HCC 96 [47%]），LR-4 类别包括 202 个病变（HCC 173 [87%]）。
CEUS LI-RADS 类别 LR-5 对 HCC 具有高度特异性，可用于有信心的非侵入性诊断。
这是一项对约 1000 个 HCC 高危局灶性病变的回顾性研究。本研究表明，LI-RADS® 引入的 HCC 典型增强超声模式的精细定义实际上消除了其他恶性实体（如胆管细胞癌）误诊 HCC 的风险，而敏感性几乎没有降低。这些数据支持使用增强超声诊断肝硬化中的 HCC。
