Role of Contrast-Enhanced Ultrasound as a Second-Line Diagnostic Modality in Noninvasive Diagnostic Algorithms for Hepatocellular Carcinoma

• Published in: Korean journal of radiology 2021, 22(3), , pp.354-365
• Main Authors: Kang, Hyo Jin, Lee, Jeong Min, Yoon, Jeong Hee, Han, Joon Koo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - diagnostic imaging; Contrast agents; Contrast Media - chemistry; Female; Gadolinium DTPA - chemistry; Gastrointestinal Imaging; Humans; Image Processing, Computer-Assisted; Liver - diagnostic imaging; Liver cancer; Liver cirrhosis; Liver Neoplasms - diagnosis; Liver Neoplasms - diagnostic imaging; Magnetic Resonance Imaging - standards; Male; Middle Aged; Pathology; Prospective Studies; Reference Standards; Sensitivity and Specificity; Ultrasonic imaging; Ultrasonography - standards; Young Adult; 방사선과학
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2020.0973

To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar's test. The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, = 0.06 by EASL; 86.1%, < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, < 0.01; 86.1% vs. 91.1% by KCLA-NCC, = 0.04). There were no false-positive cases for HCC on CEUS. The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.