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Pathological considerations of CEUS LI-RADS: correlation with fibrosis stage and tumour histological grade

  • Ultrasound
  • Published:
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Abstract

Objectives

To evaluate the influence of pathological factors, such as fibrosis stage and histological grade, on the Liver Imaging Reporting and Data System (LI-RADS) v2017 category of contrast-enhanced ultrasonography (CEUS) in patients with high risk of hepatocellular carcinoma (HCC).

Materials and methods

Between June 2015 and December 2016, 441 consecutive patients at high risk of HCC with 460 pathologically proven HCCs were enrolled in this retrospective study. All patients underwent a CEUS examination. The major features (arterial phase hyperenhancement, late and mild washout) were assessed, and LI-RADS categories were assigned according to CEUS LI-RADS v2017. CEUS LI-RADS categories and major features were compared in different histological grades and fibrosis stages.

Results

The CEUS LR-5 category was more frequently assigned in the low-grade group (151/280) than in the high-grade group (66/159) (p = 0.013), whereas the LR-TIV category was more frequently assigned in the high-grade group (36/159) than in the low-grade group (40/280) (p = 0.035). CEUS LI-RADS category was not significantly different among different fibrosis stages (p ≥ 0.05). Arterial phase hyperenhancement (APHE) and the hepatic fibrosis stage showed a significant correlation in HCCs ≥ 2 cm and the low-grade group (p = 0.027 and p = 0.003, respectively). No major features of CEUS LI-RADS showed statistically significant differences between the low- and high-grade groups (p ≥ 0.05).

Conclusion

Hepatic fibrosis stage can influence APHE but showed no impact on the CEUS LI-RADS classification, whereas the histological grade of HCC influenced the LR-5 and LR-TIV categories.

Key Points

• Histological grade influenced CEUS LR-5 and LR-TIV category (p = 0.013 and p = 0.035 respectively). Low-grade HCCs occurred more frequently in LR-5 category whereas high-grade HCCs occurred more frequently in LR-TIV category.

• Fibrosis stage shows significant influence on APHE on HCCs of the size ≥ 2 cm and low-grade group (p = 0.027 and p = 0.003, respectively).

• Hepatic fibrosis stage and HCC histological grade exhibited limited impact on CEUS LI-RADS. CEUS LI-RADS may be feasible for diagnosing HCC in patients regardless of histological grade and fibrosis stage.

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Abbreviations

ACR:

American College of Radiology

APHE:

Arterial phase hyperenhancement

CEUS:

Contrast-enhanced ultrasound

F:

Hepatic fibrosis stage

G:

HCC histological grade

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

US:

Ultrasound

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Funding

This study was supported by the National Natural Science Foundation of China (No. 81701701), Guangdong Medical Scientific Research Foundation (No. A2019397), and Project 5010 of clinical medicine research of Sun Yat-sen University (No. 2108020).

Author information

Author notes

  1. Mei-Qing Cheng and Hang-Tong Hu contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Mei-Qing Cheng, Hang-Tong Hu, Hui Huang, Jia-Min Pan, Meng-Fei Xian, Yang Huang, Ming Kuang, Xiao-Yan Xie, Wei Li, Wei Wang & Ming-De Lu

  2. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Ming Kuang & Ming-De Lu

Authors
  1. Mei-Qing Cheng
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Corresponding authors

Correspondence to Wei Li or Wei Wang.

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The scientific guarantor of this publication is Prof. Wei Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Cheng, MQ., Hu, HT., Huang, H. et al. Pathological considerations of CEUS LI-RADS: correlation with fibrosis stage and tumour histological grade. Eur Radiol 31, 5680–5688 (2021). https://doi.org/10.1007/s00330-020-07660-5

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  • DOI: https://doi.org/10.1007/s00330-020-07660-5

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