Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules

Eleonora Terzi, Massimo Iavarone, Maurizio Pompili, Letizia Veronese, Giuseppe Cabibbo, Mirella Fraquelli, Laura Riccardi, Ludovico De Bonis, Angelo Sangiovanni, Simona Leoni, Maria Assunta Zocco, Sandro Rossi, Nicola Alessi, Stephanie R. Wilson, Fabio Piscaglia

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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. Methods: 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). Results: 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%]). Conclusions: The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. Lay summary: 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.

Original languageEnglish
Pages (from-to)485-492
JournalJournal of Hepatology
Volume68
Issue number3
DOIs
Publication statusPublished - 2018

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Information Systems
Multicenter Studies
Hepatocellular Carcinoma
Ultrasonography
Fibrosis
Liver
Cholangiocarcinoma
Diagnostic Errors
Radiology

Keywords

  • Arterial hyperenhancement
  • Cholangiocarcinoma
  • Contrast enhanced ultrasound
  • Liver Imaging Reporting And Data System (LI-RADS)
  • Washout

ASJC Scopus subject areas

  • Hepatology

Cite this

Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. / Terzi, Eleonora; Iavarone, Massimo; Pompili, Maurizio; Veronese, Letizia; Cabibbo, Giuseppe; Fraquelli, Mirella; Riccardi, Laura; De Bonis, Ludovico; Sangiovanni, Angelo; Leoni, Simona; Zocco, Maria Assunta; Rossi, Sandro; Alessi, Nicola; Wilson, Stephanie R.; Piscaglia, Fabio.

In: Journal of Hepatology, Vol. 68, No. 3, 2018, p. 485-492.

Research output: Contribution to journalArticle

Terzi, E, Iavarone, M, Pompili, M, Veronese, L, Cabibbo, G, Fraquelli, M, Riccardi, L, De Bonis, L, Sangiovanni, A, Leoni, S, Zocco, MA, Rossi, S, Alessi, N, Wilson, SR & Piscaglia, F 2018, 'Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules', Journal of Hepatology, vol. 68, no. 3, pp. 485-492. https://doi.org/10.1016/j.jhep.2017.11.007
Terzi, Eleonora ; Iavarone, Massimo ; Pompili, Maurizio ; Veronese, Letizia ; Cabibbo, Giuseppe ; Fraquelli, Mirella ; Riccardi, Laura ; De Bonis, Ludovico ; Sangiovanni, Angelo ; Leoni, Simona ; Zocco, Maria Assunta ; Rossi, Sandro ; Alessi, Nicola ; Wilson, Stephanie R. ; Piscaglia, Fabio. / Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. In: Journal of Hepatology. 2018 ; Vol. 68, No. 3. pp. 485-492.
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abstract = "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{\circledR}]) 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. Methods: 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). Results: 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{\%}]). Conclusions: The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. Lay summary: 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{\circledR}) 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.",
keywords = "Arterial hyperenhancement, Cholangiocarcinoma, Contrast enhanced ultrasound, Liver Imaging Reporting And Data System (LI-RADS), Washout",
author = "Eleonora Terzi and Massimo Iavarone and Maurizio Pompili and Letizia Veronese and Giuseppe Cabibbo and Mirella Fraquelli and Laura Riccardi and {De Bonis}, Ludovico and Angelo Sangiovanni and Simona Leoni and Zocco, {Maria Assunta} and Sandro Rossi and Nicola Alessi and Wilson, {Stephanie R.} and Fabio Piscaglia",
year = "2018",
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language = "English",
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T1 - Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules

AU - Terzi, Eleonora

AU - Iavarone, Massimo

AU - Pompili, Maurizio

AU - Veronese, Letizia

AU - Cabibbo, Giuseppe

AU - Fraquelli, Mirella

AU - Riccardi, Laura

AU - De Bonis, Ludovico

AU - Sangiovanni, Angelo

AU - Leoni, Simona

AU - Zocco, Maria Assunta

AU - Rossi, Sandro

AU - Alessi, Nicola

AU - Wilson, Stephanie R.

AU - Piscaglia, Fabio

PY - 2018

Y1 - 2018

N2 - 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. Methods: 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). Results: 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%]). Conclusions: The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. Lay summary: 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.

AB - 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. Methods: 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). Results: 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%]). Conclusions: The CEUS LI-RADS class LR-5 is highly specific for HCC, enabling its use for a confident non-invasive diagnosis. Lay summary: 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.

KW - Arterial hyperenhancement

KW - Cholangiocarcinoma

KW - Contrast enhanced ultrasound

KW - Liver Imaging Reporting And Data System (LI-RADS)

KW - Washout

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