Real-life assessment of standardized contrast-enhanced ultrasound (CEUS) and CEUS algorithms (CEUS LI-RADS®/ESCULAP) in hepatic nodules in cirrhotic patients—a prospective multicenter study

URN to cite this document:

urn:nbn:de:bvb:355-epub-564466 Copy

DOI to cite this document:

10.5283/epub.56446 Copy

Strobel, D. ; Jung, E.-M. ; Ziesch, M. ; Praktiknjo, M. ; Link, A. ; Dietrich, C. F. ; Klinger, C. ; Schultheiß, M. ; Jesper, D. ; Schellhaas, B.

License: Creative Commons Attribution 4.0 PDF - Published Version (12MB)

Date of publication of this fulltext: 29 Feb 2024 12:28

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Details

Item type:	Article
Open Access Type:	DEAL (Springer) - Non UR
Journal or Publication Title:	European Radiology
Publisher:	Springer
Place of Publication:	NEW YORK
Volume:	31
Number of Issue or Book Chapter:	10
Page Range:	pp. 7614-7625
Date:	15 April 2021
Institutions:	Medicine > Lehrstuhl für Röntgendiagnostik
Identification Number:	Value Type 10.1007/s00330-021-07872-3 DOI
Keywords:	FOCAL LIVER-LESIONS; HEPATOCELLULAR-CARCINOMA; DIFFERENTIAL-DIAGNOSIS; 20 MM; RADS; GUIDELINES; ACCURACY; MANAGEMENT; RISK; Carcinoma; hepatocellular; Ultrasonography; Contrast media; Liver; Diagnostic imaging
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Partially
Item ID:	56446

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Abstract

Objectives Hepatocellular carcinoma (HCC) can be diagnosed non-invasively with contrast-enhanced ultrasound (CEUS) in cirrhosis if the characteristic pattern of arterial phase hyperenhancement followed by hypoenhancement is present. Recent studies suggest that diagnosis based on this "hyper-hypo" pattern needs further refinement. This study compares the diagnostic accuracies of standardized CEUS ...

Abstract

Objectives Hepatocellular carcinoma (HCC) can be diagnosed non-invasively with contrast-enhanced ultrasound (CEUS) in cirrhosis if the characteristic pattern of arterial phase hyperenhancement followed by hypoenhancement is present. Recent studies suggest that diagnosis based on this "hyper-hypo" pattern needs further refinement. This study compares the diagnostic accuracies of standardized CEUS for HCC according to the current guideline definition and following the newly developed CEUS algorithms (CEUS LI-RADS (R), ESCULAP) in a prospective multicenter real-life setting. Methods Cirrhotic patients with liver lesions on B-mode ultrasound were recruited prospectively from 04/2018 to 04/2019, and clinical and imaging data were collected. The CEUS standard included an additional examination point after 4-6 min in case of no washout after 3 min. The diagnostic accuracies of CEUS following the guidelines ("hyper-hypo" pattern), based on the examiner's subjective interpretation ("CEUS subjective"), and based on the CEUS algorithms ESCULAP and CEUS LI-RADS (R) were compared. Results In total, 470 cirrhotic patients were recruited in 43 centers. The final diagnosis was HCC in 378 cases (80.4%) according to the reference standard (histology 77.4%, MRI 16.4%, CT 6.2%). The "hyper-hypo" pattern yielded 74.3% sensitivity and 63% specificity. "CEUS subjective" showed a higher diagnostic accuracy (sensitivity, 91.5%; specificity, 67.4%; positive predictive value, 92%; negative predictive value, 66%). Sensitivity was higher for ESCULAP (95%) and "CEUS subjective" (91.5%) versus CEUS LI-RADS (R) (65.2%; p < 0.001). Specificity was highest for CEUS LI-RADS (R) (78.6%; p < 0.001). Conclusions CEUS has an excellent diagnostic accuracy for the non-invasive diagnosis of HCC in cirrhosis. CEUS algorithms may be a helpful refinement of the "hyper-hypo" pattern defined by current HCC guidelines.

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Metadata last modified: 11 Sep 2024 09:51

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