Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China.
AJR Am J Roentgenol. 2022 Sep;219(3):434-443. doi: 10.2214/AJR.22.27521. Epub 2022 Apr 20.
Contrast-enhanced ultrasound (CEUS) LI-RADS version 2017 (v2017) applies only to CEUS examinations performed using pure blood pool agents, noting that future versions will address combined blood pool and Kupffer cell agents such as perfluorobutane. Such agents may improve hepatocellular carcinoma (HCC) detection by visualization of a defect in the Kupffer phase (obtained ≥ 10 minutes after injection). The purpose of our study was to compare the diagnostic performance of the LR-5 category for HCC detection in at-risk patients between CEUS LI-RADS v2017 and proposed modified criteria for CEUS examinations performed using perfluorobutane. This retrospective study included 293 patients at risk for HCC (259 men, 34 women; mean age, 55 ± 12 [SD] years) who underwent CEUS using perfluorobutane from March 1, 2020, to October 30, 2020, showing a total of 304 observations (274 HCC, 14 non-HCC malignancy, and 16 benign lesions). Two readers independently assessed examinations and assigned categories using both CEUS LI-RADS v2017 and the proposed modified criteria. In the modified criteria, observations 10 mm or greater with not rim arterial phase hyperenhancement (APHE), no washout, and a Kupffer defect were upgraded from LR-4 to LR-5, and observations 10 mm or greater with not rim APHE, early washout, and a mild Kupffer defect were reassigned from LR-M to LR-5. Interreader agreement was assessed, and consensus interpretations were reached. Diagnostic performance was evaluated. Interreader agreement for LI-RADS category assignments, expressed using kappa coefficients, was 0.839 for CEUS LI-RADS v2017 and 0.854 for the modified criteria. Modified criteria upgraded 35 observations from LR-4 to LR-5 on the basis of a Kupffer defect, of which 34 were HCC and one was benign. Modified criteria reassigned 22 observations from LR-M to LR-5 on the basis of a mild Kupffer defect, of which all were HCC. LR-5 using modified criteria, compared with CEUS LI-RADS v2017, had significantly increased sensitivity (89% vs 69%, < .001), a nonsignificant decrease in specificity (83% vs 87%, > .99), and significantly increased accuracy (89% vs 71%, < .001) for HCC. When using perfluorobutane for CEUS in at-risk patients, modified criteria incorporating Kupffer defects significantly improve sensitivity without significant loss of specificity in HCC detection. Future CEUS LI-RADS updates seeking to address the use of combined blood pool and Kupffer cell agents should consider adoption of the explored criteria.
对比增强超声（CEUS）LI-RADS 版本 2017（v2017）仅适用于使用纯血池造影剂进行的 CEUS 检查，注意未来的版本将涉及联合血池和枯否细胞造影剂，如全氟丁烷。这些造影剂可以通过观察枯否细胞期的缺损（注射后≥ 10 分钟获得）来提高肝细胞癌（HCC）的检出率。本研究的目的是比较 CEUS LI-RADS v2017 和改良的用于全氟丁烷的 CEUS 检查的 LR-5 类别标准在高危患者中检测 HCC 的诊断性能。这项回顾性研究纳入了 293 名有 HCC 风险的患者（259 名男性，34 名女性；平均年龄 55±12[SD]岁），这些患者于 2020 年 3 月 1 日至 2020 年 10 月 30 日使用全氟丁烷进行了 CEUS，总共进行了 304 次观察（274 次 HCC，14 次非 HCC 恶性肿瘤，16 次良性病变）。两位读者独立评估了检查结果，并使用 CEUS LI-RADS v2017 和拟议的改良标准分别对其进行了分类。在改良标准中，直径≥ 10mm 的病灶，动脉期无环形增强（APHE）、无廓清且存在枯否细胞缺损的病灶，由 LR-4 升级为 LR-5；直径≥ 10mm 的病灶，动脉期无环形增强、早期廓清且存在轻度枯否细胞缺损的病灶，由 LR-M 重新分类为 LR-5。评估了两位读者的一致性，并达成共识。评估了诊断性能。以 Kappa 系数表示，LI-RADS 类别赋值的两位读者之间的一致性为 CEUS LI-RADS v2017 的 0.839 和改良标准的 0.854。改良标准基于枯否细胞缺损将 35 次观察由 LR-4 升级为 LR-5，其中 34 次为 HCC，1 次为良性。改良标准基于轻度枯否细胞缺损将 22 次观察从 LR-M 重新分类为 LR-5，均为 HCC。与 CEUS LI-RADS v2017 相比，使用改良标准的 LR-5 对 HCC 的敏感性显著提高（89%对 69%，<0.001），特异性无显著下降（83%对 87%，>0.99），准确性显著提高（89%对 71%，<0.001）。在高危患者中使用全氟丁烷进行 CEUS 时，纳入枯否细胞缺损的改良标准可显著提高 HCC 的检出率，而特异性无明显降低。未来旨在解决联合血池和枯否细胞造影剂使用的 CEUS LI-RADS 更新应考虑采用所探讨的标准。
