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.