Contrast-enhanced ultrasound Liver Imaging Reporting and Data System:Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

作     者：Gianpaolo Vidili Marco Arru Giuliana Solinas Diego Francesco Calvisi Pierluigi Meloni Assunta Sauchella Davide Turilli Claudio Fabio Antonio Cossu Giordano Madeddu Sergio Babudieri Maria Assunta Zocco Giovanni Iannetti Enza Di Lembo Alessandro Palmerio Delitala Roberto Manetti 

作者机构：Department of MedicalSurgical and Experimental SciencesUniversity of SassariSassari 07100Italy Department of Biomedical SciencesPublic Health-Laboratory of BiostatisticsUniversity of SassariSassari 07100Italy Department of Internal Medicine and GastroenterologyFondazione Policlinico Universitario A.Gemelli IRCCSCatholic UniversityRome 00168Italy Ultrasound UnitOspedale S.SpiritoPescara 65123Italy 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2022年第28卷第27期

页      面：3488-3502页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by the Fondazione di Sardegna,No.FDS2019VIDILI the University of Sassari,No.FAR2019 

主　　题：Contrast-enhanced ultrasound Liver Imaging Reporting and Data System Hepatocellular carcinoma Intrahepatic cholangiocarcinoma Cirrhosis Contrast-enhanced ultrasound Liver 

摘      要：BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this *** though data from the literature seems promising,its reliability in real-life context has not been well-established *** To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in *** CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver *** diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and *** frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also ***-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was *** CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P0.001),while the agreement among raters from separate centres was subst