Comparison of modified CEUS LI‐RADS with sonazoid and CT/MRI LI‐RADS for diagnosis of hepatocellular carcinoma

Abstract Aim To compare the diagnostic performance based on the modified CEUS Liver Imaging Reporting and Data System (LI‐RADS), which includes Kupffer‐phase findings as a major imaging feature, with that of CT and MRI (CT/MRI) LI‐RADS for liver nodules in patients at high risk of HCC. Methods A total of 120 patients with 120 nodules were included in this retrospective study. The median size of the lesions was 20.0 mm (interquartile range, 14.0–30.8 mm). Of these lesions, 90.0% (108 of 120) were confirmed as HCCs, 6.7% (8 of 120) were intrahepatic cholangiocarcinomas, 1.7% (2 of 120) were metastases, and 1.7% (2 of 120) were dysplastic nodules. All nodules were diagnosed histopathologically. Each nodule was categorized according to the modified CEUS LI‐RADS and CT/MRI LI‐RADS version 2018. The diagnostic performance and inter‐modality agreement of each criterion was compared. Results The inter‐modality agreement for the modified CEUS LI‐RADS and CT/MRI LI‐RADS was slight agreement (kappa = 0.139, p = 0.015). The diagnostic accuracies of HCCs for the modified CEUS LR‐5 and CT/MRI LR‐5 were 70.0% (95% confidence interval [CI]: 61.0%, 78.0%) versus 70.8% (95% CI: 61.8%, 78.8%) ( p = 0.876), respectively. The diagnostic accuracies of non‐HCC malignancies for the modified CEUS LR‐M and CT/MRI LR‐M were 84.2% (95% CI: 76.4%, 90.2%) versus 96.7% (95% CI: 91.7%, 99.1%) ( p = 0.002), respectively. Conclusions The diagnostic performance for HCCs on the modified CEUS LR‐5 and CT/MRI LR‐5 are comparable. In contrast, CT/MRI LR‐M has better diagnostic performance for non‐HCC malignancy than that of the modified CEUS LR‐M.