Qiao Andee, Samuel Anna S, Merrill Christina, Brahmania Mayur, Wilson Stephanie R
University of Calgary, Calgary, Canada.
Abdom Radiol (NY). 2025 Jan 18. doi: 10.1007/s00261-024-04651-8.
Contrast enhanced ultrasound (CEUS) now joins the ranks of CT and MRI for noninvasive diagnosis of hepatocellular carcinoma (HCC). CEUS LI-RADS provides greater than 95% specificity for diagnosis within LR-5. Unlike CT/MRI, CEUS is nodule based. Currently, LI-RADS does not recommend CEUS of nodules occult or invisible on pre-contrast ultrasound except by experts. This study addresses our ability to find occult nodules using CEUS and to characterize them with CEUS LI-RADS.
100 patients at risk for HCC, 81 with cirrhosis, with occult lesions were retrospectively identified from our archived patient logs. All patients had CEUS examination. Three specialized CEUS techniques (blindshot injection, portal venous (PVP) sweep of the liver, and on-top injection) are used to evaluate nodules.
There were 114 occult lesions in 100 patients. The origin of 78(68%) lesions was an MRI (n = 69) or CT scan (n = 9) with an observation of abnormal enhancement, generally arterial phase hyperenhancement (APHE). All these patients had blindshot CEUS injection looking for a correlate with APHE. The remainder of occult lesions (n = 36)(32%) were first detected during CEUS, generally as washout foci on PVP sweeps or incidental APHE or washout nearby other targets. All washout areas had subsequent on-top injection to assess for APHE. Application of CEUS LI-RADS algorithm categorized 26 LR-5, 34 LR-4, and 5 LR-M. CEUS upgraded LI-RADS category of 24/50(48%) occult lesions reported on CT/MRI. 29(25%) occult lesions were offered treatment and from categories LR-5 and LR-M, 5 had biopsy confirmation and 15 were treated. From both sources, MR/CT and CEUS, there were 12 occult lesions scanned for treatment response, categorized as 7 LR-TR viable, 1 LR-TR nonviable, and 4 LR-TR equivocal on CEUS.
Our study shows we can find and characterize occult nodules using CEUS techniques and CEUS LI-RADS algorithm, with positive impact on clinical management.
超声造影（CEUS）现已加入CT和MRI的行列，用于肝细胞癌（HCC）的无创诊断。CEUS LI-RADS对LR-5内的诊断特异性高于95%。与CT/MRI不同，CEUS是以结节为基础的。目前，LI-RADS不建议对在造影前超声检查中隐匿或不可见的结节进行CEUS检查，除非由专家进行。本研究探讨了我们使用CEUS发现隐匿结节并通过CEUS LI-RADS对其进行特征描述的能力。
从我们的存档患者记录中回顾性识别出100例有HCC风险的患者，其中81例有肝硬化，存在隐匿性病变。所有患者均接受了CEUS检查。使用三种专门的CEUS技术（盲注注射、肝脏门静脉（PVP）扫描和顶部注射）来评估结节。
100例患者中有114个隐匿性病变。78个（68%）病变起源于MRI（n = 69）或CT扫描（n = 9），观察到异常强化，通常为动脉期高增强（APHE）。所有这些患者均接受了盲注CEUS注射，以寻找与APHE相关的病变。其余隐匿性病变（n = 36）（32%）在CEUS检查期间首次被检测到，通常表现为PVP扫描中的洗脱灶，或在其他目标附近偶然出现的APHE或洗脱。所有洗脱区域随后均进行了顶部注射以评估APHE。应用CEUS LI-RADS算法分类为26个LR-5、34个LR-4和5个LR-M。CEUS将CT/MRI报告的24/50（48%）隐匿性病变的LI-RADS类别进行了升级。29个（25%）隐匿性病变接受了治疗，在LR-5和LR-M类别中，5个经活检证实，15个接受了治疗。来自MR/CT和CEUS这两个来源，共有12个隐匿性病变进行了治疗反应扫描，在CEUS上分类为7个LR-TR存活、1个LR-TR不存活和4个LR-TR不明确。
我们的研究表明，我们可以使用CEUS技术和CEUS LI-RADS算法发现并描述隐匿结节，对临床管理有积极影响。
