Yang Huang1, Wei Li1, Huang-Tong Hu1, Si-Min Ruan1, Meng-Fei Xian1, Xiao-Yan Xie1, Ming-De Lu1,2, Ming Kuang1,2, Li-Da Chen3, Wei Wang4. 1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China. 2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. 3. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China. chenlda@mail.sysu.edu.cn. 4. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, Ultrasomics Artificial Intelligence X-Lab, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China. wangw73@mail.sysu.edu.cn.
Abstract
PURPOSE: To assess the diagnostic performance of contrast-enhanced (CE) US Liver Imaging Reporting and Data System (LI-RADS) version 2017 and propose a diagnostic algorithm in diagnosing hepatocellular carcinoma (HCC) in patients with occult HBV infection (OBI). METHODS: 251 OBI patients with 251 newly diagnosed focal liver lesions were retrospectively enrolled. Each nodule was evaluated according to CEUS LI-RADS. The subgroup analyses were also performed in patients with alpha-fetoprotein (AFP) more than 20ug/L or not. Diagnostic performance of CEUS LI-RADS for diagnosing HCC was validated via sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV), respectively. RESULTS: There were 90 HCCs (90 of 251, 35.9%), of which 2 (2.0%), 53 (53.5%), and 35 (35.4%) were classified as LR-4, LR-5, and LR-M, respectively. The sensitivity, specificity, accuracy, PPV, and NPV of CEUS LR-5 for HCC diagnosis were 58.9%, 88.8%, 78.1%, 74.6%, and 79.4%, respectively. AFP increased in 50.6% (45/89) HCCs. Using a proposed diagnostic algorithm (for OBI patients with AFP more than 20 ug/L, LR-5 nodules were diagnosed as definitely HCC), the sensitivity, specificity, accuracy, PPV, and NPV were 62.2%, 71.4%, 63.5%, 93.3%, and 22.7%, respectively. Therefore, 12.2% (30 of 246) nodules could be confirmed as HCC by CEUS without biopsy. CONCLUSION: HCC diagnosis in patients with OBI is challenging. However, using LR-5 as a noninvasively diagnostic standard in OBI patients with AFP more than 20ug/L, HCC could be confirmed by CEUS without biopsy.
PURPOSE: To assess the diagnostic performance of contrast-enhanced (CE) US Liver Imaging Reporting and Data System (LI-RADS) version 2017 and propose a diagnostic algorithm in diagnosing hepatocellular carcinoma (HCC) in patients with occult HBV infection (OBI). METHODS: 251 OBI patients with 251 newly diagnosed focal liver lesions were retrospectively enrolled. Each nodule was evaluated according to CEUS LI-RADS. The subgroup analyses were also performed in patients with alpha-fetoprotein (AFP) more than 20ug/L or not. Diagnostic performance of CEUS LI-RADS for diagnosing HCC was validated via sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV), respectively. RESULTS: There were 90 HCCs (90 of 251, 35.9%), of which 2 (2.0%), 53 (53.5%), and 35 (35.4%) were classified as LR-4, LR-5, and LR-M, respectively. The sensitivity, specificity, accuracy, PPV, and NPV of CEUS LR-5 for HCC diagnosis were 58.9%, 88.8%, 78.1%, 74.6%, and 79.4%, respectively. AFP increased in 50.6% (45/89) HCCs. Using a proposed diagnostic algorithm (for OBI patients with AFP more than 20 ug/L, LR-5 nodules were diagnosed as definitely HCC), the sensitivity, specificity, accuracy, PPV, and NPV were 62.2%, 71.4%, 63.5%, 93.3%, and 22.7%, respectively. Therefore, 12.2% (30 of 246) nodules could be confirmed as HCC by CEUS without biopsy. CONCLUSION: HCC diagnosis in patients with OBI is challenging. However, using LR-5 as a noninvasively diagnostic standard in OBI patients with AFP more than 20ug/L, HCC could be confirmed by CEUS without biopsy.
Authors: Satinder P Kaur; Arslan Talat; Hamidreza Karimi-Sari; Andrew Grees; Hao Wei Chen; Daryl T Y Lau; Andreea M Catana Journal: J Clin Med Date: 2022-02-21 Impact factor: 4.241