Clinical impact of CEUS on non-characterizable observations and observations with intermediate probability of malignancy on CT/MRI in patients at risk for HCC.

Autor: Kono Y; Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA. ykono@health.ucsd.edu., Piscaglia F; Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., Wilson SR; University of Calgary, Calgary, Canada., Medellin A; University of Calgary, Calgary, Canada., Rodgers SK; Thomas Jefferson University Hospital, Philadelphia, PA, USA.; Einstein Medical Center, Philadelphia, PA, USA., Planz V; Vanderbilt University, Nashville, TN, USA., Kamaya A; Stanford University, Stanford, CA, USA., Fetzer DT; UT Southwestern Medical Center, Dallas, TX, USA., Berzigotti A; Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland., Sidhu PS; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.; Department of Radiology, King's College Hospital, London, UK., Wessner CE; Thomas Jefferson University Hospital, Philadelphia, PA, USA., Bradigan K; Thomas Jefferson University Hospital, Philadelphia, PA, USA., Kuon Yeng Escalante CM; Thomas Jefferson University Hospital, Philadelphia, PA, USA., Siu Xiao T; Thomas Jefferson University Hospital, Philadelphia, PA, USA., Eisenbrey JR; Thomas Jefferson University Hospital, Philadelphia, PA, USA., Forsberg F; Thomas Jefferson University Hospital, Philadelphia, PA, USA., Lyshchik A; Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Abdominal radiology (New York) [Abdom Radiol (NY)] 2024 Aug; Vol. 49 (8), pp. 2639-2649. Date of Electronic Publication: 2024 Jun 11.
DOI: 10.1007/s00261-024-04305-9
Abstrakt: Background: Hepatocellular carcinoma (HCC) is a unique cancer allowing tumor diagnosis with identification of definitive patterns of enhancement on contrast-enhanced imaging, avoiding invasive biopsy. However, it is still unclear to what extent Contrast-Enhanced Ultrasound (CEUS) is a clinically useful additional step when Computed tomography (CT) or Magnetic resonance imaging (MRI) are inconclusive.
Methods: A prospective international multicenter validation study for CEUS Liver Imaging Reporting and Data System (LI-RADS) was conducted between January 2018 and August 2021. 646 patients at risk for HCC with focal liver lesions were enrolled. CEUS was performed using an intravenous ultrasound contrast agent within 4 weeks of CT/MRI. Liver nodules were categorized based on LI-RADS (LR) criteria. Histology or one-year follow-up CT/MRI imaging results were used as the reference standard. The diagnostic performance of CEUS was evaluated for inconclusive CT/MRI scan in two scenarios for which the AASLD recommends repeat imaging or imaging follow-up: observations deemed non-characterizable (LR-NC) or with indeterminate probability of malignancy (LR-3).
Results: 75 observations on CT or MRI were categorized as LR-3 (n = 54) or LR-NC (n = 21) CEUS recategorization of such observations into a different LR category (namely, into one among LR-1, LR-2, LR-5, LR-M, or LR-TIV) resulted in management recommendation changes in 33.3% (25/75) and in all but one (96.0%, 24/25) observation, the new management recommendations were correct.
Conclusion: CEUS LI-RADS resulted in management recommendations change in substantial number of liver observations with initial indeterminate CT/MRI characterization, identifying both non-malignant lesions and HCC, potentially accelerating the diagnostic process and alleviating the need for biopsy or follow-up imaging.
Clinicaltrials: gov number, NCT03318380.
(© 2024. The Author(s).)
Databáze: MEDLINE
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