The role of contrast-enhanced ultrasound in the radiological classification of liver observations identified by CT and MRI.

IF 9.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiologia Medica Pub Date : 2025-03-24 DOI:10.1007/s11547-025-01995-z

Hui Huang, Dan-Ni He, Rui-Fang Lu, Wen-Juan Tong, Ying Wang, Si Qin, Rong Wen, Shao-Hong Wu, Si-Min Ruan, Guang-Jian Liu, Ming-De Lu, Ming Kuang, Wei Wang, Mei-Qing Cheng, Hong Yang, Li-Da Chen

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引用次数: 0

Abstract

Background & aims: Timely and accurate diagnosis of hepatocellular carcinoma (HCC) is essential for improving patient outcomes and guiding treatment. This multicenter study aimed to optimize the diagnostic workflow for HCC through a step-wise combination of CT/MRI and contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS).

Methods: This was a multicenter, retrospective analysis of prospectively recruited high-risk HCC participants with liver observations from 4 institutions, between January 2017 and December 2021. These participants initially underwent CT/MRI followed by CEUS, with observations categorized according to CT/MRI/CEUS LI-RADS. Three step-wise diagnostic strategies were evaluated, starting with CT/MRI and followed by CEUS, and compared to CT/MRI LI-RADS alone. Performance metrics included AUC, accuracy, sensitivity, specificity, PPV, and NPV, using pathology or over one year of follow-up as standards. The impact on clinical decisions was measured by false-negative, false-positive, and biopsy rates.

Results: Of 1264 participants, 874 (69%) were confirmed as HCC. The step-wise strategies outperformed CT/MRI LI-RADS. Strategy-3, which involved subsequent CEUS for CT/MRI LR-3/4 observations, significantly improved sensitivity (88.8% vs. 79.9%, P < 0.001) while maintaining comparable specificity (88.2% vs. 91.3%, P > 0.05). Strategy-3 reduced biopsy rate (31.5-22.4%, P = 0.028) and decreased false-negative rate (20.1-11.2%, P < 0.001). Additionally, 96% (55/57) of CT/MRI LR-3 and 97% (77/79) of CT/MRI LR-4 observations were accurately diagnosed and treated as HCC, with 61% (74/121) of CT/MRI LR-4 observations avoiding biopsy with CEUS-assisted.

Conclusion: A step-wise approach using CT/MRI followed by CEUS for LR-3/4 observations improved the diagnostic performance and further refined clinical decision-making in HCC.

Trial registration: Clinical Trial Registration Number: ChiCTR-DDD-16010089.

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背景和目的：及时准确地诊断肝细胞癌（HCC）对于改善患者预后和指导治疗至关重要。这项多中心研究旨在通过逐步结合 CT/MRI 和对比增强超声（CEUS）肝脏成像报告和数据系统（LI-RADS）来优化 HCC 的诊断工作流程：这是一项多中心回顾性分析，研究对象是2017年1月至2021年12月期间从4家机构招募的具有肝脏观察结果的前瞻性高风险HCC参与者。这些参与者首先接受 CT/MRI 检查，然后接受 CEUS 检查，并根据 CT/MRI/CEUS LI-RADS 对观察结果进行分类。评估了从 CT/MRI 开始，然后是 CEUS 的三种分步诊断策略，并与单独的 CT/MRI LI-RADS 进行了比较。性能指标包括AUC、准确性、灵敏度、特异性、PPV和NPV，以病理学或一年以上的随访为标准。对临床决策的影响通过假阴性率、假阳性率和活检率来衡量：在 1264 名参与者中，874 人（69%）被确诊为 HCC。分步策略的效果优于 CT/MRI LI-RADS。策略-3涉及CT/MRI LR-3/4观察结果的后续CEUS，显著提高了灵敏度（88.8% vs. 79.9%，P 0.05）。策略-3 降低了活检率（31.5%-22.4%，P = 0.028），并减少了假阴性率（20.1%-11.2%，P 结论：CT/MRI LR-3/4 观察结果与 CT/MRI LR-3/4 观察结果之间的差异很小：对LR-3/4的观察采用先CT/MRI后CEUS的分步法，提高了HCC的诊断性能，并进一步完善了临床决策：临床试验注册号：ChiCTR-DDD-160100ChiCTR-DDD-16010089。

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来源期刊

Radiologia Medica 医学-核医学

CiteScore

14.10

自引率

7.90%

发文量

133

审稿时长

4-8 weeks

期刊介绍： Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.