Background & Aims. The use of contrast enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC) in cirrhosis was questioned for the risk of false positive diagnosis in case of cholangiocarcinoma. The American College of Radiology has recently released a scheme (CEUS LI-RADS) classifying lesions at risk for HCC investigated by CEUS. Aim of the present study was to validate this LI-RADS scheme for the diagnosis of HCC. Methods. A total of 1006 nodules in 848 patients with chronic liver disease at risk for HCC collected in 5 Italian centers were retrospectively analyzed. Nodules were classified as LR-5, (HCC) if ≥ 1 cm with arterial phase hyperenhancement, and late washout (onset ≥60 seconds 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 (=506) or histology (n=500). Results. Median size was 2 cm. Of 1006 nodules, HCC were 820 (81%), cholangiocarcinoma 40 (4%), regenerative nodules (±dysplastic) 116 (11%). 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.

中文翻译：

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对比增强超声识别肝硬化中的肝细胞癌：一项大型多中心回顾性研究

背景和目标。使用对比增强超声 (CEUS) 诊断肝硬化中的肝细胞癌 (HCC) 被质疑在胆管癌的情况下存在假阳性诊断的风险。美国放射学会最近发布了一项计划 (CEUS LI-RADS)，对 CEUS 调查的 HCC 风险病变进行分类。本研究的目的是验证该 LI-RADS 方案用于 HCC 的诊断。方法。回顾性分析了在意大利 5 个中心收集的 848 名有 HCC 风险的慢性肝病患者的 1006 个结节。如果结节 ≥ 1 cm 且动脉期高强化，且晚期清除（注射造影剂后≥60 秒），则结节被归类为 LR-5，（HCC）。边缘增强和/或早期和/或显着清除的合格病变为 LR-M（恶性、但不是特定于 HCC）。其他组合符合 HCC (LR-3) 或可能 HCC (LR-4) 中等风险的病变。诊断参考标准是 HCC 的 CT/MRI 诊断 (=506) 或组织学 (n=500)。结果。中位数为 2 厘米。在 1006 个结节中，HCC 为 820 (81%)，胆管癌 40 (4%)，再生性结节 (±发育不良) 116 (11%)。LR-5 类别（占所有结节的 52%）对 HCC 的预测率为 98.5%，没有误诊为纯胆管癌的风险。对 HCC 的敏感性为 62%。所有 LR-M 结节都是恶性的，并且大部分是非肝细胞来源的。超过 75% 的胆管癌是 LR-M。LR-3 类别包括 203 个病变 (HCC 96=47%) 和 LR-4 202 (HCC 173=87%)。结论。CEUS LI-RADS LR-5 类对 HCC 具有高度特异性，使其可用于可靠的非侵入性诊断。