LI-RADS CEUS Nonradiation TRA Version 2024: Application on HCC Patients Treated With Ablation Treatment

Objective: To evaluate the performance of Liver Imaging Reporting and Data System (LI-RADS) contrast-enhanced ultrasound (CEUS) Nonradiation treatment response assessment (TRA) categorization v2024 for detecting viable tumors of ablated hepatocellular carcinoma (HCC). Methods: Between June 2020 and December 2022, standardized CEUS data of HCC patients were prospectively collected. A retrospective analysis of LI-RADS CEUS Nonradiation TRA v2024 evaluation on HCCs was conducted by 2 independent radiologists assigning per-lesion TRA (TR-nonviable, TR-equivocal, or TR-viable) categorizations. Inter-reader agreement between the 2 readers and inter-modality agreement between LI-RADS CEUS and CT/MRI LI-RADS TRA were assessed. The diagnostic performance of imaging criteria was explored. The potential influencing factors of LI-RADS TRA categorization across modalities were further analyzed. Results: A total of 101 CEUS-LI-RADS TRA category evaluations of 88 lesions in 83 patients were included. Interreader agreement for the 2 readers were substantial to almost perfect (intralesional tumor viability: kappa = 0.92, 95% CI: 0.76-1.0; perilesional tumor viability: kappa = 0.72, 95% CI: 0.57-0.87; CEUS LR-TR: kappa = 0.71, 95% CI: 0.55-0.88). Inter-modality agreements between CEUS and CT/MRI LI-RADS TRA categorizations were excellent (ICC = 0.90). CEUS LR-TRA categorization demonstrated good diagnostic performance, particularly in specificity (88.1%-100 %) and negative predictive value (NPV: 93.9%-97.9 %). Time period and abstract shape were identified as significant factors influencing reader evaluations (p <0.05). Conclusion: LI-RADS CEUS Nonradiation TRA v2024 demonstrates fine inter-reader and inter-modality agreement, with outstanding diagnostic performance, supporting its potential for clinical application in assessing treatment response for ablated HCC.