Hwang Jeong Ah, Jeong Woo Kyoung, Min Ji Hye, Kim Yeun-Yoon, Heo Nam Hun, Lim Hyo Keun
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ultrasonography. 2021 Oct;40(4):486-498. doi: 10.14366/usg.20120. Epub 2021 Jan 15.
The aim of this study was to evaluate the association of contrast-enhanced ultrasound (CEUS) features using Sonazoid for liver nodules with Liver Imaging Reporting and Data System (LI-RADS) categories and to identify the usefulness of Kupffer-phase images.
This retrospective study was conducted in 203 patients at high risk of hepatocellular carcinoma (HCC) who underwent CEUS with Sonazoid from 2013 to 2016. Nodule enhancement in the arterial, portal venous, late, and Kupffer phases; CEUS LI-RADS major features; and Kupffer-phase defects were evaluated. According to the computed tomography/magnetic resonance imaging (CT/MRI) LI-RADS v2018, all nodules were assigned an LR category (n=4/33/99/67 for LR-M/3/4/5) and comparisons across LR categories were made. We defined modified CEUS LI-RADS as using Kupffer-phase defects as an alternative to late and mild washout in CEUS LI-RADS and compared the diagnostic performance for HCC.
On CEUS of 203 nodules, 89.6% of CT/MRI LR-5 and 85.9% of LR-4 nodules showed hyperenhancement in the arterial phase, while 57.6% of LR-3 nodules showed hyperenhancement. Among the CT/MRI LR-5 nodules that showed arterial phase hyperenhancement or isoenhancement, 59.7% showed hypoenhancing changes from the portal venous phase, 23.9% from the late phase, and 13.4% additionally in the Kupffer phase. The modified CEUS LI-RADS showed higher sensitivity than CEUS LI-RADS (83.2% vs. 74.2%, P=0.008) without compromising specificity (63.6% vs. 69.7%, P=0.500).
The Kupffer phase best shows hypoenhancing changes in LR-5 lesions and is expected to improve the sensitivity for HCC in high-risk patients.
本研究旨在评估使用声诺维进行肝脏结节超声造影（CEUS）的特征与肝脏影像报告和数据系统（LI-RADS）分类之间的相关性，并确定库普弗期图像的有用性。
本回顾性研究纳入了2013年至2016年期间接受声诺维CEUS检查的203例肝细胞癌（HCC）高危患者。评估动脉期、门静脉期、延迟期和库普弗期的结节强化情况；CEUS LI-RADS主要特征；以及库普弗期缺损。根据计算机断层扫描/磁共振成像（CT/MRI）LI-RADS v2018，所有结节被指定一个LR类别（LR-M/3/4/5分别为n = 4/33/99/67），并对不同LR类别进行比较。我们将改良的CEUS LI-RADS定义为使用库普弗期缺损替代CEUS LI-RADS中的延迟期和轻度廓清，并比较其对HCC的诊断性能。
在203个结节的CEUS检查中，89.6%的CT/MRI LR-5结节和85.9%的LR-4结节在动脉期表现为高增强，而57.6%的LR-3结节表现为高增强。在CT/MRI LR-5结节中，表现为动脉期高增强或等增强的结节中，59.7%在门静脉期出现低增强变化，23.9%在延迟期出现，13.4%在库普弗期额外出现。改良的CEUS LI-RADS显示出比CEUS LI-RADS更高的敏感性（83.2%对74.2%，P = 0.008），且不影响特异性（63.6%对69.7%，P = 0.500）。
库普弗期最能显示LR-5病变的低增强变化，有望提高高危患者HCC的敏感性。
