The Value of CEUS LI-RADS Combined with AFP in Early Diagnosis of Hepatocellular Carcinoma in Low- and High-Risk Patients

Abstract

Abstract Background We found that the incidence rate of hepatocellular carcinoma (HCC) has increased significantly in non-cirrhotic patients, with HCC being frequently overlooked or misdiagnosed. Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is known to have a high diagnostic value in high-risk HCC patients. Therefore, we aimed to compare the diagnostic value of CEUS LI-RADS for HCC between low- (LR) and high-risk (HR) patients, to confirm its value in LR patients. In addition, since CEUS LR-4 and LR-M categories contain a relatively high proportion of HCC, and serum alpha-fetoprotein (AFP) is the most used HCC biomarker, and the clinically valid, we attempted to further improve the early diagnostic value of CEUS LI-RADS for HCC in the LR and HR patients by combining CEUS LR-4 and LR-M categories with AFP. Methods We enrolled 189 HCC patients with LR and HR in a retrospective study. All lesions were confirmed histopathologically. Diagnostic performance of CEUS LI-RADS for HCC in these two patients was compared. In addition, we analyzed the value of CEUS LI-RADS as a valid method of establishing the early diagnosis for HCC in LR and HR patients by combining LR-4 and LR-M category with AFP. Results Through comparative analysis, we found that, due to the high proportion of HCC in CEUS LR-4 and LR-M categories in our cases, the specificity of CEUS LR-5 category for HCC in the HR group was 78.4%, whereas in the LR group it was 94.2%. Meanwhile, the sensitivity (63.2% vs 63.0%) and positive predictive value (PPV) (75.0% vs 88.7%) did not differ between the LR and HR groups (P = 0.299, P = 0.965). It is noteworthy that when we combined CEUS LR-4 and LR-M categories with AFP significantly improved the sensitivity and PPV by 21.0%, 5.0% in the LR group, and by 16.0%, 2.1% in the HR group (P = 0.836, P = 0.836, respectively). Conclusions The CEUS LR-5 category has real clinical value in diagnosing HCC in both LR and HR patients. The early diagnostic value of CEUS LI-RADS category for HCC patients was further increased when CEUS LR-4 and LR-M categories was combined with elevated AFP.