Can Modifications of LR-M Criteria Improve the Diagnostic Performance of Contrast-Enhanced Ultrasound LI-RADS for Small Hepatic Lesions up to 3 cm?

Objective-To assess the diagnostic performance of the contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) version 2017 for small hepatic lesions of <= 3 cm before and after changing the LR-M criteria. Methods-We retrospectively analyzed the CEUS examination of 179 patients who were at high risk of hepatocellular carcinoma (HCC) with focal hepatic lesions <= 3 cm (194 lesions in total) and evaluated the diagnostic capability of the American College of Radiology and modified CEUS LI-RADS algorithms. Results-Revision of the early washout time to 45 seconds increased the sensitivity of LR-5 in predicting HCC (P = .04), with no significant decrease in specificity (P = .118). It also made better the specificity of LR-M in predicting non-HCC malignancies (P = .001), with no significant decrease in sensitivity (P = .094). However, using within 3 minutes as the criterion for marked washout time improved the LR-5 sensitivity (P < .001) but decreased its specificity (P = .009) in predicting HCC, whereas the specificity of LR-M in predicting non-HCC malignancies increased (P < .001), but the sensitivity decreased (P = .027). Conclusions-CEUS LI-RADS (v2017) is a valid method for predicting HCC risk in high-risk patients. The diagnostic performance of LR-5 and LR-M could boost when the early washout time is revised to 45 seconds.