An assessment of liver lesions using a combination of CEUS LI-RADS and AFP

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Abstract
Purpose To improve noninvasive diagnosis of HCC using a combination of CE US LI-RADS and alpha-fetoprotein (AFP). Methods 757 solitary liver nodules from 757 patients at risk of HCC with CE US and serum AFP test were categorized as LR-1 to LR-5 through LR-M according to CE US LI-RADS version 2017. In LR-3, LR-4, and LR-M nodules, those with AFP > 200 ng/ml were reclassified as mLR-5. Nodules with LR-5 and mLR-5 were reclassified as definitely HCC to modify CE US LI-RADS. Diagnostic performance was assessed with specificity, sensitivity, and PPV. Results The sensitivity, specificity, and PPV of LR-5 as a predictor of HCC were 64.7%, 97.8%, and 98.9%, respectively. 32.1% patients with solitary liver nodule had AFP greater than 200 ng/ml, of which 98.8% were HCC (25.8%, 7.5%, 2.5% assigned to LR-M, LR-4, LR-3, respectively) and 1.2% were Combined Hepatocellular Cholangiocarcinoma. After modification, the sensitivity increased to 79.6% (P < 0.001), while specificity and PPV remained high (96.6% and 98.7%, P > 0.050). Conclusion The combination of CE US LI-RADS and AFP for diagnosing HCC improved diagnostic sensitivity significantly, while maintaining high PPV and specificity in patients with the solitary liver nodule. Graphical abstract
Funding Information
  • National Natural Science Foundation of China (81971630, 82171960, 82102078)
  • Guangzhou Municipal Science and Technology Program key projects (201904010187)
  • Natural Science Foundation of Guangdong Province (2021B1515020054)

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