Hyo-Jin Kang1,2, Jung Hoon Kim3,4,5, Ijin Joo1,2, Joon Koo Han1,2,6. 1. Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea. 2. Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea. 3. Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea. jhkim2008@gmail.com. 4. Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea. jhkim2008@gmail.com. 5. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, South Korea. jhkim2008@gmail.com. 6. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, South Korea.
Abstract
PURPOSE: To determine the added value of CEUS on arterial phase non-hyperenhancement (APNHE) observations (LR-3 and LR-4) of CT/MRI in high-risk patients. METHODS: Forty-three patients with APNHE observations (≥ 2 cm) from CT/MRI were prospectively enrolled in this IRB-approved study and underwent CEUS. All observations were assessed by LI-RADS for CT/MRI and CEUS. The hemodynamic findings were compared. The mean follow-up period was 11.8 ± 2.1 months. Reference standard was made on 34-APNHE observations based on biopsy (n = 2), surgery (n = 2), and follow-up image (n = 30). RESULTS: The median of observation size was 2.3 cm (IQR 2.0-2.5 cm). Among the 43-APNHE observations, 12-observations (27.9%) were further presented as arterial phase hyperenhancement (APHE) in CEUS with early (n = 1, CEUS LR-M), late (n = 10, CEUS LR-5), or no (n = 1, CEUS LR-4) washout. Compared to CT, CEUS presented concordant enhancement patterns in 16 (44.4%) in AP and 20 (55.6%) in PVP, respectively. Similarly, 13 (59.1%) and 14 (63.6%) observations showed concordant enhancement patterns between CEUS and MRI in AP and PVP, respectively. Of the 34-APNHE observations with final diagnosis (hepatocellular carcinoma [HCC] n = 12; intrahepatic cholangiocarcinoma [IHCC], n = 1; non-malignancy, n = 21), 4 HCCs (33.3%) and 1 IHCC (100%) were additionally diagnosed by CEUS, while 1 non-malignant lesion (4.5%) was misdiagnosed as HCC by CEUS. CONCLUSION: Adding CEUS to APNHE observations from CT/MRI would be useful not only for definitely diagnosing HCC (CEUS LR-5) but also for other malignancies (CEUS LR-M). The discordance of dynamic features between the LI-RADS for CEUS and CT/MRI may reflect the different properties of contrast media, although the systems are not interchangeable.
PURPOSE: To determine the added value of CEUS on arterial phase non-hyperenhancement (APNHE) observations (LR-3 and LR-4) of CT/MRI in high-risk patients. METHODS: Forty-three patients with APNHE observations (≥ 2 cm) from CT/MRI were prospectively enrolled in this IRB-approved study and underwent CEUS. All observations were assessed by LI-RADS for CT/MRI and CEUS. The hemodynamic findings were compared. The mean follow-up period was 11.8 ± 2.1 months. Reference standard was made on 34-APNHE observations based on biopsy (n = 2), surgery (n = 2), and follow-up image (n = 30). RESULTS: The median of observation size was 2.3 cm (IQR 2.0-2.5 cm). Among the 43-APNHE observations, 12-observations (27.9%) were further presented as arterial phase hyperenhancement (APHE) in CEUS with early (n = 1, CEUS LR-M), late (n = 10, CEUS LR-5), or no (n = 1, CEUS LR-4) washout. Compared to CT, CEUS presented concordant enhancement patterns in 16 (44.4%) in AP and 20 (55.6%) in PVP, respectively. Similarly, 13 (59.1%) and 14 (63.6%) observations showed concordant enhancement patterns between CEUS and MRI in AP and PVP, respectively. Of the 34-APNHE observations with final diagnosis (hepatocellular carcinoma [HCC] n = 12; intrahepatic cholangiocarcinoma [IHCC], n = 1; non-malignancy, n = 21), 4 HCCs (33.3%) and 1 IHCC (100%) were additionally diagnosed by CEUS, while 1 non-malignant lesion (4.5%) was misdiagnosed as HCC by CEUS. CONCLUSION: Adding CEUS to APNHE observations from CT/MRI would be useful not only for definitely diagnosing HCC (CEUS LR-5) but also for other malignancies (CEUS LR-M). The discordance of dynamic features between the LI-RADS for CEUS and CT/MRI may reflect the different properties of contrast media, although the systems are not interchangeable.