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Combining CEUS and CT/MRI LI-RADS major imaging features: diagnostic accuracy for classification of indeterminate liver observations in patients at risk for HCC.

Combining CEUS and CT/MRI LI-RADS major imaging features: diagnostic accuracy for classification of indeterminate liver observations in patients at risk for HCC. Abdominal radiology (New York) Siu Xiao, T., Kuon Yeng Escalante, C. M., Tahmasebi, A., Kono, Y., Piscaglia, F., Wilson, S. R., Medellin-Kowalewski, A., Rodgers, S. K., Planz, V., Kamaya, A., Fetzer, D. T., Berzigotti, A., Radu, I., Sidhu, P. S., Wessner, C. E., Bradigan, K., Eisenbrey, J. R., Forsberg, F., Lyshchik, A. 2024

Abstract

PURPOSE: To determine the diagnostic accuracy of combining CEUS and CT/MRI LI-RADS major imaging features for the improved categorization of liver observations indeterminate on both CT/MRI and CEUS.MATERIALS AND METHODS: A retrospective analysis using a database from a prospective study conducted at 11 centers in North America and Europe from 2018 to 2022 included a total of 109 participants at risk for HCC who had liver observations with indeterminate characterization (LR3, LR-4, and LR-M) on both CEUS and CT/MRI. The individual CEUS and CT/MRI LI-RADS major features were extracted from the original study and analyzed in various combinations. Reference standards included biopsy, explant histology, and follow-up CT/MRI. The diagnostic performance of the combinations of LI-RADS major features for definitive diagnosis of HCC was calculated. A reverse, stepwise logistical regression sub-analysis was also performed.RESULTS: This study included 114 observations indeterminate on both CT/MRI and CEUS. These observations were categorized as LR-3 (n=37), LR-4 (n=41), and LR-M (n=36) on CT/MRI and LR-3 (n=48), LR-4 (n=36), LR-M (n=29), and LR-TIV (n=1) on CEUS. Of them, 43.0% (49/114) were confirmed as HCC, 37.3% (43/114) non-malignant, and 19.3% (22/114) non-hepatocellular malignancies. The highest diagnostic accuracy among the combinations of imaging features was achieved in CT/MRI LR-3 observations, where the combination of CEUS arterial phase hyper-enhancement (APHE)+CT/MRI APHE had 96.7% specificity, 75.0% positive predictive value (PPV), and 86.5% accuracy for HCC.CONCLUSION: The combination of LI-RADS major features on CT/MRI and CEUS showed higher specificity, PPV, and accuracy compared to individual modalities' assessments, particularly for CT/MRI LR-3 observations.

View details for DOI 10.1007/s00261-024-04625-w

View details for PubMedID 39438285