Academic radiology · 2026
Diagnostic Performance of CEUS LI-RADS for Hepatocellular Carcinoma ≤ 30 mm in Chinese Expanded High-Risk Patients: A Multicenter Analysis.
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Liu Li, Tan Ying, Tang Chunling, Chen Ping, Chen Kaixuan, Wang Yue, Tan Yingyue, Wu Wenyang, Tan Ling, Yang Dan, Zhu Lianhua, Guo Yanli
Аннотация
RATIONALE AND OBJECTIVES: We aimed to validate and optimize the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for diagnosing small hepatocellular carcinoma (sHCC; ≤ 30 mm) in a Chinese expanded high-risk population: a viral-related liver disease or cirrhosis (VC) group, and a non-VC group with non-cirrhotic, non-viral liver disease, including alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease.
MATERIALS AND METHODS: This multicenter study included 856 liver nodules (≤ 30 mm) from 815 patients, divided into retrospective derivation and prospective validation cohorts. CEUS LI-RADS v2017 was applied, then optimized by (1) tightening the early-washout cutoff from < 60 s to < 50 s, reclassifying LR-M lesions with washout onset from 50 to < 60 s as LR-5+; and (2) integrating serum alpha-fetoprotein (AFP) > 20 ng/mL, reclassifying LR-4/LR-M nodules as LR-5++. Standard and optimized criteria were compared using accuracy, sensitivity, specificity, and positive predictive value (PPV).
RESULTS: Across cohorts, standard LR-5 showed high specificity (87.67-93.01%) but suboptimal sensitivity (57.69-64.41%). In the validation cohort, LR-5++ significantly improved sensitivity from 57.69% to 71.43% (P < 0.05) and accuracy from 73.23% to 80.31% (P < 0.05), while specificity decreased slightly from 93.01% to 91.61% without reaching statistical significance. In subgroup analysis, LR-5++ improved sensitivity in both subgroups, most markedly in the VC group.
CONCLUSION: A study-derived modification of CEUS LI-RADS incorporating AFP >20 ng/mL (LR-5++) improved diagnostic performance for sHCC in this cohort, addressing the limitated sensitivity of the standard algorithm.
MATERIALS AND METHODS: This multicenter study included 856 liver nodules (≤ 30 mm) from 815 patients, divided into retrospective derivation and prospective validation cohorts. CEUS LI-RADS v2017 was applied, then optimized by (1) tightening the early-washout cutoff from < 60 s to < 50 s, reclassifying LR-M lesions with washout onset from 50 to < 60 s as LR-5+; and (2) integrating serum alpha-fetoprotein (AFP) > 20 ng/mL, reclassifying LR-4/LR-M nodules as LR-5++. Standard and optimized criteria were compared using accuracy, sensitivity, specificity, and positive predictive value (PPV).
RESULTS: Across cohorts, standard LR-5 showed high specificity (87.67-93.01%) but suboptimal sensitivity (57.69-64.41%). In the validation cohort, LR-5++ significantly improved sensitivity from 57.69% to 71.43% (P < 0.05) and accuracy from 73.23% to 80.31% (P < 0.05), while specificity decreased slightly from 93.01% to 91.61% without reaching statistical significance. In subgroup analysis, LR-5++ improved sensitivity in both subgroups, most markedly in the VC group.
CONCLUSION: A study-derived modification of CEUS LI-RADS incorporating AFP >20 ng/mL (LR-5++) improved diagnostic performance for sHCC in this cohort, addressing the limitated sensitivity of the standard algorithm.