Dynamic contrast-enhanced ultrasound with quantitative analysis optimizes LI-RADS for hepatocellular carcinoma diagnosis: a multicenter study.

Purpose: To investigate the value of dynamic contrast-enhanced ultrasound (DCE-US) analysis using the Liver Imaging Reporting and Data System (LI-RADS) to improve the diagnosis of hepatocellular carcinoma (HCC).

Methods: This multicenter study retrospectively enrolled consecutive high-risk patients for HCC who underwent contrast-enhanced ultrasound (CEUS) between December 2022 and June 2023. Quantitative CEUS analysis was performed using VueBox^® to obtain diagnostic parameters for HCC. These parameters were used as auxiliary indicators to reassign the LI-RADS categories. The reference standard was pathologic confirmation or composite criteria. The diagnostic performance of LI-RADS with and without quantitative DCE-US parameters was assessed.

Results: 269 patients (median age, 61 years [interquartile range, 52-69]; 206 men, 63 women) with 269 focal liver lesions (FLLs) (median size, 40 mm [interquartile range, 25-62 mm]) were included. Among the 269 FLLs, 227 were HCC, 31 non-HCC malignancies, and 11 benign lesions. DCE-US analysis showed HCC had higher rise time (RT) and fall time (FT) at the lesion margin than non-HCC malignancies (both P < 0.05) but lower RT and FT than benign lesions (both P < 0.05). RT at the lesion margin (range 17.48 s-21.16 s) serves as an auxiliary indicator for HCC diagnosis. Compared to CEUS LI-RADS, the revised LR-5 improved sensitivity (61.7 vs. 52.8%, P < 0.001) without a significant decrease in specificity (76.2 vs. 83.3%, P = 0.25) for diagnosing HCC.

Conclusion: DCE-US quantitative analysis improved the sensitivity for HCC diagnosis without affecting specificity, thereby optimizing the diagnostic performance of CEUS LI-RADS.