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Surveillance for malignant progression of LI-RADS version 2017 category 3/4 nodules using contrast-enhanced ultrasound

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To identify the risk factors for predicting the malignant progression of LR-3/4 observations on the baseline and contrast-enhanced ultrasound (CEUS).

Methods

In total, 245 liver nodules assigned to LR-3/4 in 192 patients from January 2010 to December 2016 were followed up by baseline US and CEUS. The differences in the rate and time of progression to hepatocellular carcinoma (HCC) among subcategories (defined as P1-P7) of LR-3/4 in CEUS Liver Imaging Reporting and Data System (LI-RADS) were analyzed. The risk factors to predict progression to HCC were analyzed by univariate and multivariate Cox proportional hazard model analysis.

Results

A total of 40.3% of LR-3 nodules and 78.9% of LR-4 nodules eventually progressed to HCC. The cumulative incidence of progression was significantly higher for LR-4 than LR-3 (p < 0.001). The rate of progression was 81.2% in nodules with arterial phase hyperenhancement (APHE), 64.7% in nodules with late and mild washout, and 100% in nodules with both characteristics. The overall progression rate and median progression time of subcategory P1 nodules (LR-3a) were lower (38.0% vs. 47.6–100.0%) and later (25.1 months vs. 2.0–16.3 months) than those of other subcategories. The cumulative incidence of progression of LR-3a (P1), LR-3b (P2/3/4), and LR-4 (P5/6/7) categories were 38.0%, 52.9%, and 78.9%. The risk factors of HCC progression were Visualization score B/C, CEUS characteristics (APHE, washout), LR-4 classification, echo changes, and definite growth.

Conclusion

CEUS is a useful surveillance tool for nodules at risk of HCC. CEUS characteristics, LI-RADS classification, and changes in nodules provide useful information for the progress of LR-3/4 nodules.

Clinical relevance statement

CEUS characteristics, LI-RADS classification, and nodule changes provide important predictions for LR-3/4 nodule progression to HCC, which may stratify the risk of malignant progression to provide a more optimized and refined, more cost-effective, and time-efficient management strategy for patients.

Key Points

• CEUS is a useful surveillance tool for nodules at risk of HCC, CEUS LI-RADS successfully stratified the risks that progress to HCC.

• CEUS characteristics, LI-RADS classification, and changes in nodules can provide important information on the progression of LR-3/4 nodules, which may be helpful for a more optimized and refined management strategy.

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Abbreviations

APHE :

Arterial phase hyperenhancement

CEUS :

Contrast-enhanced ultrasound

CI :

Confidence interval

HCC :

Hepatocellular carcinoma

HR :

Hazard ratio

LI-RADS :

Liver Imaging Reporting and Data System

TIV:

Tumor in vein

US :

Ultrasound

VIS :

Visualization Score

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Funding

This study was supported by the National Nature Science Foundation of China (NO: 82171960, 82102078, and 81971630), Guangdong Natural Science Foundation (NO: 2021B1515020054, 2022A1515011148, 2021B1515120030), Guangzhou Science and Technology Project (NO: 201904010187), and Guangdong Medical Scientific Research Foundation (NO: A2021344).

Author information

Author notes

  1. Hui Huang, Chao-qun Li, and Dan-ni He contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Hui Huang, Chao-qun Li, Dan-ni He, Si-min Ruan, Ming-de Li, Mei-qing Cheng, Ming-de Lu, Ming Kuang, Wei Wang & Li-da Chen

  2. Department of Ultrasound Medicine, West China **amen Hospital of Sichuan University, **amen, China

    Chao-qun Li

  3. Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China

    Dan-ni He

  4. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Ming-de Lu & Ming Kuang

  5. Department of Medical Ultrasound, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang West Road, Guangzhou, 510120, China

    Ying Wang

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  1. Hui Huang
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Corresponding authors

Correspondence to Ying Wang or Li-da Chen.

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The scientific guarantor of this publication is Li-da Chen.

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There are no conflicts of interest to declare.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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Huang, H., Li, Cq., He, Dn. et al. Surveillance for malignant progression of LI-RADS version 2017 category 3/4 nodules using contrast-enhanced ultrasound. Eur Radiol 33, 9336–9346 (2023). https://doi.org/10.1007/s00330-023-09811-w

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  • DOI: https://doi.org/10.1007/s00330-023-09811-w

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