Dr Barbara Schellhaas compared 2 contrast-enhanced ultrasound algorithms for the diagnosis of hepatocellular carcinoma in high-risk patients, including Erlanger Synopsis of Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at Risk (ESCULAP) and American College of Radiology Contrast-Enhanced Ultrasound-Liver Imaging Reporting and Data System.
Focal liver lesions in 100 high-risk patients were assessed using both contrast-enhanced ultrasound algorithms for a direct comparison.
The team categorized lesions according to size and contrast enhancement in the arterial, portal venous and late phases.
For the definite diagnosis of hepatocellular carcinoma, categories ESCULAP-4, ESCULAP-Tr and ESCULAP-V and contrast-enhanced ultrasound-LI-RADS-LR-5, LR-Tr and LR-5-V were compared.
|The diagnostic accuracy for intrahepatic cholangiocellular carcinoma was identical with both algorithms|
|European Journal of Gastroenterology & Hepatology|
In addition, contrast-enhanced ultrasound-LI-RADS-category LR-M, and ESCULAP-category C were compared.
Histology, ontrast-enhanced-computed tomography and ontrast-enhanced-MRI served as reference standards.
The researchers found that the reference standard among 100 lesions included 87 hepatocellular carcinomas, 6 intrahepatic cholangiocellular carcinomas and 7 non-hepatocellular carcinoma-non-intrahepatic cholangiocellular carcinoma-lesions.
For the diagnosis of hepatocellular carcinoma, the team noted that the diagnostic accuracy of contrast-enhanced ultrasound was significantly higher with ESCULAP versus contrast-enhanced ultrasound-LI-RADS.
The researchers observed that the sensitivity, specificity and positive predictive value and negative predictive value for ESCULAP/contrast-enhanced ultrasound-LI-RADS were 94%/72%; 62%/69%; 94%/94%; and 62%/27%, respectively.
The diagnostic accuracy for intrahepatic cholangiocellular carcinoma was identical with both algorithms, with higher positive predictive value for ESCULAP-C versus LR-M.
Dr Schellhaas' team concludes, "Contrast-enhanced ultrasound-based algorithms contribute toward standardized assessment and reporting of hepatocellular carcinoma-suspect lesions in high-risk patients."
"ESCULAP shows significantly higher diagnostic accuracy, sensitivity and negative predictive value with no loss of specificity compared with contrast-enhanced ultrasound-LI-RADS."
"Both algorithms have an excellent positive predictive value."
"Arterial hyperenhancement is the key feature for the diagnosis of hepatocellular carcinoma with contrast-enhanced ultrasound."
"Washout should not be a necessary prerequisite for the diagnosis of definite hepatocellular carcinoma."
"Contrast-enhanced ultrasound-LI-RADS in its current version is inferior to ESCULAP for the noninvasive diagnosis of hepatocellular carcinoma."
"There are 2 ways to improve contrast-enhanced ultrasound-LI-RADS, including the combination of the categories LR-4 and LR-5 for the diagnosis of definite hepatocellular carcinoma, and the use of subtotal infiltration of a liver lobe as an additional feature."