Sonazoid-enhanced ultrasound: comparison with CT/MRI Liver Imaging Reporting And Data System (LI-RADS) in patients with suspected hepatocellular carcinoma
Jeong Ah Hwang1 , Woo Kyoung Jeong1 , Ji Hye Min1 , Yeun-Yoon Kim2 , Nam Hun Heo3 , Hyo Keun Lim1
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
3Soonchunhyang University Cheonan Hospital, Cheonan, Korea
Corresponding Author: Woo Kyoung Jeong ,Tel: 02-3410-1923, Fax: 02-3410-0049, Email:
Received: August 5, 2020;  Accepted: January 15, 2021.  Published online: January 15, 2021.
To evaluate the association of contrast-enhanced ultrasound (CEUS) features using Sonazoid for liver nodules with Liver Imaging Reporting And Data System (LI-RADS) category and to identify the usefulness of Kupffer phase images.
This retrospective study was conducted in 203 patients at high risk of hepatocellular carcinoma (HCC) who underwent CEUS with Sonazoid from 2013 to 2016. The nodule enhancement in the arterial, portal venous, late, and Kupffer phases, CEUS LI-RADS major features and Kupffer phase defect was evaluated. According to CT/MRI LI-RADS v2018, all nodules were assigned by LR category (n = 4/33/99/67 for LR-M/3/4/5) and comparisons across LR categories were made. We defined modified CEUS LI-RADS by which “Kupffer phase defect” is an alternative to “late and mild washout” of CEUS LI-RADS and compared the diagnostic performance for HCC.
On CEUS of 203 nodules, 89.6% of CT/MRI LR-5 and 85.9% of LR-4 showed hyperenhancement in the arterial phase, while 57.6% of LR-3 showed hyperenhancement. Among CT/MRI LR-5 nodules that showed arterial phase hyper- or isoenhancement, 59.7% showed hypoenhancing change from the portal venous phase, 23.9% from the late phase, and 13.4% additionally in the Kupffer phase. Modified CEUS LI-RADS showed higher sensitivity than CEUS LI-RADS (83.2% vs 74.2%, P = 0.008) without compromising the specificity (63.6% vs 69.7%, P = 0.500).
Kupffer phase best shows hypoenhancing changes in the LR-5 lesions and is expected to improve the sensitivity for HCC in patients at high risk.
Keywords: Ultrasonography; Contrast media; Kupffer cells; Liver neoplasms; Hepatocellular carcinoma
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