Dynamic Contrast-Enhanced Ultrasonography Combined With LR-M Classification Criteria for Differentiating Malignant Liver Nodules at High Risk for Hepatocellular Carcinoma

Shibo Qiu; Jianmin Ding; Yandong Wang; Hongyu Zhou; Lin Zhao; Lei Zhao; Yan Zhou; Yaling Fu; Xiang Jing

doi:10.1016/j.ultrasmedbio.2024.03.016

Dynamic Contrast-Enhanced Ultrasonography Combined With LR-M Classification Criteria for Differentiating Malignant Liver Nodules at High Risk for Hepatocellular Carcinoma

Ultrasound Med Biol. 2024 Apr 17:S0301-5629(24)00145-5. doi: 10.1016/j.ultrasmedbio.2024.03.016. Online ahead of print.

Authors

Shibo Qiu¹, Jianmin Ding², Yandong Wang¹, Hongyu Zhou¹, Lin Zhao¹, Lei Zhao¹, Yan Zhou¹, Yaling Fu¹, Xiang Jing¹

Affiliations

¹ Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China.
² Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China. Electronic address: djmzyn1982@sina.com.

PMID: 38632025
DOI: 10.1016/j.ultrasmedbio.2024.03.016

Abstract

Objective: We aimed to investigate the value of quantitative parameters derived from dynamic contrast-enhanced ultrasonography (DCE-US) and a combination of these quantitative parameters with the LR-M classification criteria in distinguishing hepatocellular carcinoma (HCC) nodules and non-HCC malignancies.

Methods: HCC and non-HCC malignant nodules were grouped using pathologic results, and each nodule was classified using CEUS LI-RADS 2017. Quantitative CEUS analysis of each nodule was performed using VueBox, and quantitative parameters were compared between the HCC and non-HCC groups. The diagnostic efficacy of the LR-5 category for HCC was analyzed using the LR-M classification criteria along with time-related quantitative parameters.

Results: Of the 190 malignant liver nodules, 137 and 53 were HCCs and non-HCC malignancies, respectively. The median values of quantitative parameters RT (rise time), TTP (time to peak), mTTl (mean transit time local), and FT (fall time) in the non-HCC malignant group were lower than those in the HCC group, with p < 0.05. There was a statistically significant difference in WiAUC (wash-in area under the curve), WoAUC (wash-out area under the curve), WiWoAUC (wash-in and wash-out area under the curve), and WoR (wash-out rate) values between HCC and non-HCC malignant groups, with p < 0.05. Using LR-M washout time <60 s and FT ≤21.2 s as the new diagnostic standard, the LR-5 category showed a sensitivity of 83.9%, specificity of 96.2%, and positive predictive value of 98.3% for HCC diagnosis.

Conclusion: DCE-US can facilitate the distinction of HCCs and non-HCC malignancies. Non-HCC malignancies present with earlier peak enhancement and more rapid and marked washout than HCC nodules. The combination of the LR-M classification criteria and FT ≤21.2 s can significantly improve the diagnostic sensitivity of the LR-5 category for HCC.

Keywords: Contrast-enhanced ultrasound; Differential diagnosis; Dynamic contrast-enhanced ultrasound; Hepatocellular carcinoma; Liver Imaging Reporting and Data System.