Strategy for Accurate Diagnosis by Contrast‐Enhanced Ultrasound of Focal Liver Lesions in Patients Not at High Risk for Hepatocellular Carcinoma
Objective To develop an effective strategy for accurate diagnosis of focal liver lesions (FLLs) in patients with non‐high risk for hepatocellular carcinoma (HCC). Methods From January 2012 to December 2015, consecutive patients with non‐high risk for HCC who underwent contrast‐enhanced ultrasound (C...
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| Veröffentlicht in: | Journal of ultrasound in medicine 2023-06, Vol.42 (6), p.1333-1344 |
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| creator | Xian, Meng‐Fei Li, Wei Lan, Wen‐Tong Zeng, Dan Xie, Wen‐Xuan Lu, Ming‐De Huang, Yang Wang, Wei |
| description | Objective
To develop an effective strategy for accurate diagnosis of focal liver lesions (FLLs) in patients with non‐high risk for hepatocellular carcinoma (HCC).
Methods
From January 2012 to December 2015, consecutive patients with non‐high risk for HCC who underwent contrast‐enhanced ultrasound (CEUS) were included in this retrospective double‐reader study. All patients were stratified into 2 different risks (intermediate, low‐risk) groups according to criteria based on clinical characteristics, known as clinical risk stratification criteria. For the intermediate‐risk group, the CEUS criteria for identifying benign lesions and HCCs were constructed based on selected CEUS features. The diagnostic performance of the clinical risk stratification criteria, and CEUS criteria for identifying benign lesions and HCCs was evaluated.
Results
This study included 348 FLLs in 348 patients. The sensitivity and specificity of the clinical risk stratification criteria for malignancy was 97.8 and 69.8%. Patients were classified as intermediate risk if they were male, or older than 40 years of age, or HBcAb positive, or having positive tumor markers. Otherwise, patients were classified as low risk. Among the 348 patients, 327 were in the intermediate‐risk group and 21 were in the low‐risk group. In the intermediate‐risk group, the CEUS criteria for identifying benign lesions were any of the following features: 1) hyper/isoenhancement in the arterial phase without washout, 2) nonenhancement in all phases, 3) peripheral discontinuous globular enhancement in the arterial phase, 4) centrifugal enhancement or peripheral enhancement followed by no central enhancement, or 5) enhanced septa. The accuracy, sensitivity, and specificity of the CEUS criteria for identifying benign lesions were 94.5, 83.0, and 99.6%, respectively. Arterial phase hyperenhancement followed by mild and late washout (>60 seconds) was more common in HCC patients than in non‐HCC patients (P |
| doi_str_mv | 10.1002/jum.16151 |
| format | Article |
| fullrecord | <record><control><sourceid>wiley</sourceid><recordid>TN_cdi_wiley_primary_10_1002_jum_16151_JUM16151</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>JUM16151</sourcerecordid><originalsourceid>FETCH-LOGICAL-c801-64ad51631f18ed397628f408eb2a6dcf560d5a6f8c3d7dddc2470015ad0229df3</originalsourceid><addsrcrecordid>eNotkEtOwzAQhi0EEqWw4AZzgbS2kzjJsiotBYWHoF1Hrh-tS2pXsQPKjiMgjshJaAurf_7RpxnpQ-ia4AHBmA437XZAGEnJCeqRNMVRwUh8inqYZnmU0CI7Rxfeb_YoJlnSQ9-voeFBrTrQroGREO2hwo3hK-u88bDsYOzsHvLh5_NrYtfcCiVhUR9WrrUSnIapE7yG0ryrBkrljbMejIVnHoyywcOjC8ADzMxqDS_Gvx2fzdSOBydUXbc1b2DMG2Gs2_JLdKZ57dXVf_bRfDqZj2dR-XR7Nx6VkcgxiVjCZUpYTDTJlYyLjNFcJzhXS8qZFDplWKac6VzEMpNSCppkGJOUS0xpIXXcR8O_sx-mVl21a8yWN11FcHUQWe1FVkeR1f3i4TjEv-uVa8o</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Strategy for Accurate Diagnosis by Contrast‐Enhanced Ultrasound of Focal Liver Lesions in Patients Not at High Risk for Hepatocellular Carcinoma</title><source>Wiley Online Library</source><creator>Xian, Meng‐Fei ; Li, Wei ; Lan, Wen‐Tong ; Zeng, Dan ; Xie, Wen‐Xuan ; Lu, Ming‐De ; Huang, Yang ; Wang, Wei</creator><creatorcontrib>Xian, Meng‐Fei ; Li, Wei ; Lan, Wen‐Tong ; Zeng, Dan ; Xie, Wen‐Xuan ; Lu, Ming‐De ; Huang, Yang ; Wang, Wei</creatorcontrib><description>Objective
To develop an effective strategy for accurate diagnosis of focal liver lesions (FLLs) in patients with non‐high risk for hepatocellular carcinoma (HCC).
Methods
From January 2012 to December 2015, consecutive patients with non‐high risk for HCC who underwent contrast‐enhanced ultrasound (CEUS) were included in this retrospective double‐reader study. All patients were stratified into 2 different risks (intermediate, low‐risk) groups according to criteria based on clinical characteristics, known as clinical risk stratification criteria. For the intermediate‐risk group, the CEUS criteria for identifying benign lesions and HCCs were constructed based on selected CEUS features. The diagnostic performance of the clinical risk stratification criteria, and CEUS criteria for identifying benign lesions and HCCs was evaluated.
Results
This study included 348 FLLs in 348 patients. The sensitivity and specificity of the clinical risk stratification criteria for malignancy was 97.8 and 69.8%. Patients were classified as intermediate risk if they were male, or older than 40 years of age, or HBcAb positive, or having positive tumor markers. Otherwise, patients were classified as low risk. Among the 348 patients, 327 were in the intermediate‐risk group and 21 were in the low‐risk group. In the intermediate‐risk group, the CEUS criteria for identifying benign lesions were any of the following features: 1) hyper/isoenhancement in the arterial phase without washout, 2) nonenhancement in all phases, 3) peripheral discontinuous globular enhancement in the arterial phase, 4) centrifugal enhancement or peripheral enhancement followed by no central enhancement, or 5) enhanced septa. The accuracy, sensitivity, and specificity of the CEUS criteria for identifying benign lesions were 94.5, 83.0, and 99.6%, respectively. Arterial phase hyperenhancement followed by mild and late washout (>60 seconds) was more common in HCC patients than in non‐HCC patients (P < .001). Using arterial phase hyperenhancement followed by mild and late washout as the CEUS criteria for identifying HCCs, the sensitivity and specificity were 52.6 and 95.3%, but unfortunately, the positive predictive value was only 82.0%. For the low‐risk group, no further analysis was performed due to the small sample size.
Conclusions
Initial clinical risk stratification followed by assessment of certain CEUS features appears to be a promising strategy for the accurate diagnosis of FLLs in patients not at high risk for HCC.</description><identifier>ISSN: 0278-4297</identifier><identifier>EISSN: 1550-9613</identifier><identifier>DOI: 10.1002/jum.16151</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>diagnostic techniques and procedures ; hepatitis ; hepatocellular carcinoma ; ultrasonography</subject><ispartof>Journal of ultrasound in medicine, 2023-06, Vol.42 (6), p.1333-1344</ispartof><rights>2022 American Institute of Ultrasound in Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c801-64ad51631f18ed397628f408eb2a6dcf560d5a6f8c3d7dddc2470015ad0229df3</citedby><orcidid>0000-0002-9485-583X ; 0000-0001-7956-0526 ; 0000-0002-9771-8144 ; 0000-0002-6886-6180 ; 0000-0003-0739-0921</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjum.16151$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjum.16151$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids></links><search><creatorcontrib>Xian, Meng‐Fei</creatorcontrib><creatorcontrib>Li, Wei</creatorcontrib><creatorcontrib>Lan, Wen‐Tong</creatorcontrib><creatorcontrib>Zeng, Dan</creatorcontrib><creatorcontrib>Xie, Wen‐Xuan</creatorcontrib><creatorcontrib>Lu, Ming‐De</creatorcontrib><creatorcontrib>Huang, Yang</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><title>Strategy for Accurate Diagnosis by Contrast‐Enhanced Ultrasound of Focal Liver Lesions in Patients Not at High Risk for Hepatocellular Carcinoma</title><title>Journal of ultrasound in medicine</title><description>Objective
To develop an effective strategy for accurate diagnosis of focal liver lesions (FLLs) in patients with non‐high risk for hepatocellular carcinoma (HCC).
Methods
From January 2012 to December 2015, consecutive patients with non‐high risk for HCC who underwent contrast‐enhanced ultrasound (CEUS) were included in this retrospective double‐reader study. All patients were stratified into 2 different risks (intermediate, low‐risk) groups according to criteria based on clinical characteristics, known as clinical risk stratification criteria. For the intermediate‐risk group, the CEUS criteria for identifying benign lesions and HCCs were constructed based on selected CEUS features. The diagnostic performance of the clinical risk stratification criteria, and CEUS criteria for identifying benign lesions and HCCs was evaluated.
Results
This study included 348 FLLs in 348 patients. The sensitivity and specificity of the clinical risk stratification criteria for malignancy was 97.8 and 69.8%. Patients were classified as intermediate risk if they were male, or older than 40 years of age, or HBcAb positive, or having positive tumor markers. Otherwise, patients were classified as low risk. Among the 348 patients, 327 were in the intermediate‐risk group and 21 were in the low‐risk group. In the intermediate‐risk group, the CEUS criteria for identifying benign lesions were any of the following features: 1) hyper/isoenhancement in the arterial phase without washout, 2) nonenhancement in all phases, 3) peripheral discontinuous globular enhancement in the arterial phase, 4) centrifugal enhancement or peripheral enhancement followed by no central enhancement, or 5) enhanced septa. The accuracy, sensitivity, and specificity of the CEUS criteria for identifying benign lesions were 94.5, 83.0, and 99.6%, respectively. Arterial phase hyperenhancement followed by mild and late washout (>60 seconds) was more common in HCC patients than in non‐HCC patients (P < .001). Using arterial phase hyperenhancement followed by mild and late washout as the CEUS criteria for identifying HCCs, the sensitivity and specificity were 52.6 and 95.3%, but unfortunately, the positive predictive value was only 82.0%. For the low‐risk group, no further analysis was performed due to the small sample size.
Conclusions
Initial clinical risk stratification followed by assessment of certain CEUS features appears to be a promising strategy for the accurate diagnosis of FLLs in patients not at high risk for HCC.</description><subject>diagnostic techniques and procedures</subject><subject>hepatitis</subject><subject>hepatocellular carcinoma</subject><subject>ultrasonography</subject><issn>0278-4297</issn><issn>1550-9613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNotkEtOwzAQhi0EEqWw4AZzgbS2kzjJsiotBYWHoF1Hrh-tS2pXsQPKjiMgjshJaAurf_7RpxnpQ-ia4AHBmA437XZAGEnJCeqRNMVRwUh8inqYZnmU0CI7Rxfeb_YoJlnSQ9-voeFBrTrQroGREO2hwo3hK-u88bDsYOzsHvLh5_NrYtfcCiVhUR9WrrUSnIapE7yG0ryrBkrljbMejIVnHoyywcOjC8ADzMxqDS_Gvx2fzdSOBydUXbc1b2DMG2Gs2_JLdKZ57dXVf_bRfDqZj2dR-XR7Nx6VkcgxiVjCZUpYTDTJlYyLjNFcJzhXS8qZFDplWKac6VzEMpNSCppkGJOUS0xpIXXcR8O_sx-mVl21a8yWN11FcHUQWe1FVkeR1f3i4TjEv-uVa8o</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Xian, Meng‐Fei</creator><creator>Li, Wei</creator><creator>Lan, Wen‐Tong</creator><creator>Zeng, Dan</creator><creator>Xie, Wen‐Xuan</creator><creator>Lu, Ming‐De</creator><creator>Huang, Yang</creator><creator>Wang, Wei</creator><general>John Wiley & Sons, Inc</general><scope/><orcidid>https://orcid.org/0000-0002-9485-583X</orcidid><orcidid>https://orcid.org/0000-0001-7956-0526</orcidid><orcidid>https://orcid.org/0000-0002-9771-8144</orcidid><orcidid>https://orcid.org/0000-0002-6886-6180</orcidid><orcidid>https://orcid.org/0000-0003-0739-0921</orcidid></search><sort><creationdate>202306</creationdate><title>Strategy for Accurate Diagnosis by Contrast‐Enhanced Ultrasound of Focal Liver Lesions in Patients Not at High Risk for Hepatocellular Carcinoma</title><author>Xian, Meng‐Fei ; Li, Wei ; Lan, Wen‐Tong ; Zeng, Dan ; Xie, Wen‐Xuan ; Lu, Ming‐De ; Huang, Yang ; Wang, Wei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c801-64ad51631f18ed397628f408eb2a6dcf560d5a6f8c3d7dddc2470015ad0229df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>diagnostic techniques and procedures</topic><topic>hepatitis</topic><topic>hepatocellular carcinoma</topic><topic>ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xian, Meng‐Fei</creatorcontrib><creatorcontrib>Li, Wei</creatorcontrib><creatorcontrib>Lan, Wen‐Tong</creatorcontrib><creatorcontrib>Zeng, Dan</creatorcontrib><creatorcontrib>Xie, Wen‐Xuan</creatorcontrib><creatorcontrib>Lu, Ming‐De</creatorcontrib><creatorcontrib>Huang, Yang</creatorcontrib><creatorcontrib>Wang, Wei</creatorcontrib><jtitle>Journal of ultrasound in medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xian, Meng‐Fei</au><au>Li, Wei</au><au>Lan, Wen‐Tong</au><au>Zeng, Dan</au><au>Xie, Wen‐Xuan</au><au>Lu, Ming‐De</au><au>Huang, Yang</au><au>Wang, Wei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Strategy for Accurate Diagnosis by Contrast‐Enhanced Ultrasound of Focal Liver Lesions in Patients Not at High Risk for Hepatocellular Carcinoma</atitle><jtitle>Journal of ultrasound in medicine</jtitle><date>2023-06</date><risdate>2023</risdate><volume>42</volume><issue>6</issue><spage>1333</spage><epage>1344</epage><pages>1333-1344</pages><issn>0278-4297</issn><eissn>1550-9613</eissn><abstract>Objective
To develop an effective strategy for accurate diagnosis of focal liver lesions (FLLs) in patients with non‐high risk for hepatocellular carcinoma (HCC).
Methods
From January 2012 to December 2015, consecutive patients with non‐high risk for HCC who underwent contrast‐enhanced ultrasound (CEUS) were included in this retrospective double‐reader study. All patients were stratified into 2 different risks (intermediate, low‐risk) groups according to criteria based on clinical characteristics, known as clinical risk stratification criteria. For the intermediate‐risk group, the CEUS criteria for identifying benign lesions and HCCs were constructed based on selected CEUS features. The diagnostic performance of the clinical risk stratification criteria, and CEUS criteria for identifying benign lesions and HCCs was evaluated.
Results
This study included 348 FLLs in 348 patients. The sensitivity and specificity of the clinical risk stratification criteria for malignancy was 97.8 and 69.8%. Patients were classified as intermediate risk if they were male, or older than 40 years of age, or HBcAb positive, or having positive tumor markers. Otherwise, patients were classified as low risk. Among the 348 patients, 327 were in the intermediate‐risk group and 21 were in the low‐risk group. In the intermediate‐risk group, the CEUS criteria for identifying benign lesions were any of the following features: 1) hyper/isoenhancement in the arterial phase without washout, 2) nonenhancement in all phases, 3) peripheral discontinuous globular enhancement in the arterial phase, 4) centrifugal enhancement or peripheral enhancement followed by no central enhancement, or 5) enhanced septa. The accuracy, sensitivity, and specificity of the CEUS criteria for identifying benign lesions were 94.5, 83.0, and 99.6%, respectively. Arterial phase hyperenhancement followed by mild and late washout (>60 seconds) was more common in HCC patients than in non‐HCC patients (P < .001). Using arterial phase hyperenhancement followed by mild and late washout as the CEUS criteria for identifying HCCs, the sensitivity and specificity were 52.6 and 95.3%, but unfortunately, the positive predictive value was only 82.0%. For the low‐risk group, no further analysis was performed due to the small sample size.
Conclusions
Initial clinical risk stratification followed by assessment of certain CEUS features appears to be a promising strategy for the accurate diagnosis of FLLs in patients not at high risk for HCC.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><doi>10.1002/jum.16151</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-9485-583X</orcidid><orcidid>https://orcid.org/0000-0001-7956-0526</orcidid><orcidid>https://orcid.org/0000-0002-9771-8144</orcidid><orcidid>https://orcid.org/0000-0002-6886-6180</orcidid><orcidid>https://orcid.org/0000-0003-0739-0921</orcidid></addata></record> |
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| subjects | diagnostic techniques and procedures hepatitis hepatocellular carcinoma ultrasonography |
| title | Strategy for Accurate Diagnosis by Contrast‐Enhanced Ultrasound of Focal Liver Lesions in Patients Not at High Risk for Hepatocellular Carcinoma |
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