超声造影LI－RADS 2017版与MRI LI－RADS 2018版对肝内局灶性病变恶性风险的预测价值

目的比较超声造影(CEUS)肝脏影像报告与数据系统(LI-RADS)2017版(v2017)和磁共振成像(MRI) LI-RADS 2018版(v2018)单独以及联合应用对肝细胞癌(HCC)高危患者肝内局灶性病变(FLL)恶性风险的预测价值。方法对2018年1月至2021年10月于上海交通大学医学院附属瑞金医院及瑞金医院无锡分院同时行CEUS和增强MRI检查的212例患者300个FLL的临床和影像学资料进行回顾性分析, 入组结节均根据CEUS LI-RADS v2017和CT/MRI LI-RADS v2018分类标准进行分类, 对2种影像学LI-RADS分类结果行Cohen′s Kappa检验。以组织病理学诊断或随访结果为金标准, 比较2种影像学LI-RADS分类标准单独以及联合应用对FLL的恶性风险预测价值。结果 CEUS LI-RADS v2017和MRI LI-RADS v2018两种影像学分类标准间总体一致性中等(Kappa=0.441)。CEUS LR-5和MRI LR-5单独应用以及联合应用诊断HCC的特异性分别为93.66%、95.07%、88.73%(P>0....     

ACR CEUS LI-RADS和WFUMB-EFSUMB标准对高危人群肝细胞癌诊断价值的对比研究

目的比较美国放射学会超声造影肝脏影像报告和数据系统（ACR CEUS LI-RADS）和世界超声医学和生物学联合会-欧洲超声医学和生物学联合会（WFUMB-EFSUMB）肝脏超声造影指南对于高危人群肝细胞癌（HCC）的诊断效能。 方法回顾性分析2018年3月至2020年12月在浙江大学医学院附属第二医院就诊的HCC高危患者319例（334个病灶）,按照ACR CEUS LI-RADS 2017版和WFUMB-EFSUMB肝脏造影指南分类标准对334个病灶的超声造影视频进行判读,以手术或穿刺活检组织学病理、临床诊断及随访结果为参考标准,分析ACR CEUS LI-RADS各分级类别对HCC的诊断效能。分别计算ACR CEUS LI-RADS LR-5类和WFUMB-EFSUMB标准诊断HCC的敏感度、特异度、准确性、阳性预测值、阴性预测值及受试者操作特征（ROC）曲线下面积,采用χ²检验及DeLong's检验进行诊断效能比较。计算两者联合诊断HCC的ROC曲线下面积,并分别与2种诊断标准的ROC曲线下面积进行比较。 结果本研究纳入的334个肝脏病灶,按照ACR CEUS LI-RADS分类,LR-5类病灶114个,LR-4类病灶25个,LR-3类病灶12个,LR-M类病灶162个,每个分类诊断HCC的阳性预测值分别为93.9%、40.0%、16.7%、24.7%。ACR CEUS LI-RADS LR-5类标准与WFUMB-EFSUMB标准诊断HCC的敏感度分别为66.9%、83.8%,特异度分别为96.0%、73.0%,差异均具有统计学意义（χ²=25.037、38.025,P均＜0.001）;2种标准诊断准确性比较（82.0% vs 78.1%）,差异无统计学意义（χ²=1.352,P=0.245）;2种标准诊断HCC的ROC曲线下面积分别为0.814、0.784,差异无统计学意义（P=0.161）。两者联合诊断的ROC曲线下面积为0.857,与ACR CEUS LI-RADS LR-5类及WFUMB-EFSUMB标准比较,差异具有统计学意义（P=0.001、＜0.001）。 结论ACR CEUS LI-RADS和WFUMB-EFSUMB标准对高危人群HCC的诊断均具有较高的价值。ACR CEUS LI-RADS LR-5类标准和WFUMB-EFSUMB标准诊断HCC的效能类似。然而,2种标准在提供诊断信息时存在差异,ACR CEUS LI-RADS LR-5类标准的诊断特异度更高,而WFUMB-EFSUMB标准的诊断敏感度更高,2种标准在一定程度上可以互补。     

超声造影肝脏影像报告与数据系统对甲胎蛋白阴性患者肝脏局灶性病变恶性风险的预测价值

目的 探讨超声造影肝脏影像报告与数据系统2017版（CEUS LI-RADS v2017）对甲胎蛋白（AFP）阴性患者肝脏局灶性病变（FLL）恶性风险的预测价值。方法 选取我院行CEUS检查的108例AFP阴性FLL患者的134个结节,其中肝细胞癌（HCC）52个,非HCC恶性肿瘤（OM）22个,良性病灶60个。采用CEUS LI-RADS v2017对结节进行分类,以组织病理学结果或增强影像学检查和临床随访结果为金标准,计算CEUS LI-RADS v2017对AFP阴性患者FLL恶性风险的预测效能;绘制受试者工作特征曲线分析其曲线下面积（AUC）。结果 LR-5与LR-4、5诊断AFP阴性HCC的敏感性、特异性分别为73.08%和88.46%、93.90%和82.93%,差异均有统计学意义（均P<0.05）;AUC分别为0.84和0.86,二者比较差异无统计学意义。LR-M诊断OM的敏感性、特异性和AUC分别为90.91%、97.32%和0.94。结论 CEUS LI-RADS v2017对AFP阴性患者FLL恶性风险有一定的预测价值;其中LR-5预测HCC的特异性高而敏感性...     

超声造影肝脏影像报告与数据系统在甲胎蛋白阴性肝细胞癌高危患者中的应用

目的 研究超声造影肝脏影像报告与数据系统2017版（CEUS LI-RADS v2017）在甲胎蛋白（AFP）阴性的肝细胞癌（HCC）高危患者肝局灶性病变中的应用价值。方法 回顾性分析2018年1月至2021年10月在我院行CEUS检查的AFP阴性HCC高危患者108例（134个结节）,采用CEUS LI-RADS v2017对结节进行分类,以组织病理学结果或增强影像学检查和随访结果为金标准,计算CEUS LI-RADS对AFP阴性患者HCC和肝内其他恶性肿瘤（OM）的诊断敏感性、特异性、阳性预测值、阴性预测值、准确率、受试者工作特征曲线下面积（AUC）。结果 AFP阴性HCC较OM小（P＜0.001）。CEUS LR-5类、LR-4类、LR-3类对AFP阴性HCC的阳性预测值分别为88.37%、47.06%、12.9%。LR-5类诊断AFP阴性HCC的敏感性、特异性、准确率和AUC分别为73.07%、 93.90%、85.82%和0.87。LR-M类诊断OM的敏感性、特异性、阳性预测值、阴性预测值、准确率和AUC分别为90.91%、97.32%、86.96%、98.20%、96.27%和0.94。结论AFP阴性HCC较OM小,CEUS LI-RADS v2017对AFP阴性HCC诊断特异性较高而敏感性较低,对OM有较好的诊断价值。     

肝脏影像报告及数据管理系统(LI-RADS)对肝癌CT及MRI影像特征比较分析研究

目的:本研究旨在运用肝脏影像报告和数据管理系统(Liver Imaging Reporting and Data System,LI-RADS)对肝细胞肝癌(hepatocellular carcinoma,HCC)患者的CT及MR的影像特征进行分析,比较CT与MRI对HCC的诊断价值;方法:回顾性分析我院2013年8月至2014年12期间经手术病理确诊为HCC患者72例,术前CT及MR均同时行动态增强检查,由2名高年资主治医师根据LI-RADS v2014分级标准对CT和MRI图像分别进行评级。结果:对CT与MRI评分结果一致性kappa值为0. 566,一致性中等;两者的评分存在差异(p=0. 005);当病灶直径小于3cm时(n=33),对CT和MRI评分结果一致性kappa值为0. 115,两者一致性较差; CT与MRI LI-RADS评分存在显著的差异(p 0. 001);当病灶直径大于3cm时(n=39),对CT与MRI评分结果进行kappa值为0. 838,结果一致性很好; CT与MRI的LI-RADS评分无统计学差异(p=0. 207);结论:依据LI-RADS的影像特征,MR对HCC诊断的价值对于较小病灶(小于3cm)优于CT,对于较大病灶两者的价值相似。     

基于2018版肝脏影像报告及数据系统评估CT及MRI对小于等于3cm肝细胞性肝癌的诊断价值

目的基于2018版肝脏影像报告及数据系统(LI-RADS v2018),探讨CT及MRI对乙肝肝硬化背景下长径≤3 cm肝细胞性肝癌(hepatocellular carcinoma,HCC)的诊断价值.材料与方法回顾性分析本院2009年1月至2020年12月间73例有乙肝肝硬化病史且经病理证实占位长径≤3 cm HCC的患者,并在1个月内行CT及MRI检查.依据LI-RADS v2018,对每个病灶的CT及MRI图像的主次要征象及分级进行评估及比较.比较CT及MRI对长径≤3 cm HCC的诊断准确率.结果主要征象中的"包膜"表现在MRI中识别率高于CT(P<0.001).次要征象中的扩散受限征象(86.3％)在MRI中具有最高识别率,而在CT的次要征象中马赛克征(25.0％)的识别率最高.CT及MRI检查的LI-RADS v2018分级差异有统计学意义(P<0.001).MRI在以LR-4/5标准诊断HCC的准确率优于CT(P=0.046).结论基于LI-RADS v2018,MRI检查对长径≤3 cm HCC的部分征象的识别率及HCC诊断准确率均高于CT检查.     

CT测量残肝比在肝母细胞瘤患儿术前评估中的应用

目的 探讨CT测量残余肝脏体积比（残肝比）在肝母细胞瘤患儿术前评估中的应用价值。方法 选取40例经手术病理证实的肝母细胞瘤患儿,平均年龄（1.8±0.8）岁,术前均行增强CT检查,并测量全肝脏体积、预切除肝脏体积,计算标准化肝脏体积、残余肝脏体积,按照公式残肝比=残余肝脏体积/标准化肝脏体积×100%计算残肝比。术中以水浸法测量实际手术切除肝脏体积,并与CT测量预切除肝脏体积进行比较;以ROC曲线评价残肝比预测术后肝功能中重度与轻度损害的效能。结果 术前CT测量预切除肝脏体积为（393.62±216.54）cm³,术中以水浸法测得实际肝脏切除体积为（388.38±207.56）cm³,差异无统计学意义（t=1.679,P=0.101）。患儿残余肝脏体积为（234.55±70.42）cm³,残肝比为（63.64±13.70）%。ROC曲线结果显示残肝比预测术后肝功能中重度与轻度损害的AUC为0.837（P=0.016）,临界值为56.32%,敏感度为86.7%,特异度为70.0%。结论 肝母细胞瘤患儿术前采用CT计算残肝比,对于选择手术方案以及术后肝功能评估具有重要价值。     

R2*值预估肝细胞癌病理分级的可行性

目的 探讨增强T2^*加权血管成像（ESWAN）序列的R2^*值预估肝细胞癌（HCC）病理分级的可行性。方法 回顾性分析69例（共71个病灶）接受1.5T MR（含ESWAN序列）检查并经手术病理证实为HCC患者的影像资料,按照病理学分级分为3组,其中低分化组25个,中分化组25个,高分化组21个病灶。由2名观察者分别测量各组HCC实质区的R2^*值,检验2名观察者测量数据的一致性,并分析R2^*值与HCC病理级别的相关性,对不同级别HCC的R2^*值进行组间两两比较;采用ROC曲线评估R2^*值预估低级别HCC的效能并确定界值。结果 2名观察者测量各组数据的一致性很好（ICC>0.75）。R2^*值与HCC病理分级呈弱相关（r_s=0.493,P<0.001）,低、中和高分化组HCC的R2^*值分别为（30.57±9.95）Hz、（21.07±5.11）Hz和（19.08±4.83）Hz,低、中分化组间及低、高分化组间R2^*值差异有统计学意义（P均<0.001）,中、高分化组间差异无统计学意义（P=0.350）。应用R2^*值预估低分化HCC的曲线下面积（AUC）为0.816,以R2^*值=21.96 Hz为界值,敏感度为80.0%,特异度为73.9%。结论 R2^*值可作为MR非强化方式预估低分化HCC的定量指标。     

IVIM-DWI鉴别诊断肝细胞癌和肝局灶性结节增生

目的 探讨体素内不相干运动扩散加权成像（IVIM-DWI）鉴别肝细胞癌（HCC）与肝局灶性结节增生（FNH）的价值。方法 对407例临床疑似HCC或FNH的患者行常规上腹部MR平扫、动态增强及IVIM-DWI扫描,60例患者（40例HCC,20例FNH）入组。IVIM采用单、双指数模型获得表观扩散系数（ADC）、慢速表观扩散系数（D）、快速表观扩散系数（D^*）及快速扩散成分所占比例（f）。结果 FNH组的ADC、D、D^*及f值分别为（1.60±0.25）×10^-3mm²/s、（1.12±0.17）×10^-3mm²/s、（44.89±18.23）×10^-3mm²/s和（34.80±9.68）%;HCC组分别为（1.32±0.21）×10^-3mm²/s、（0.82±0.21）×10^-3mm²/s、（49.82±20.11）×10^-3mm²/s和（28.72±13.84）%。2组间的ADC、D值差异有统计学意义（P均<0.001）,而D^*、f值差异无统计学意义（P>0.05）。D值相应ROC曲线下面积为0.90,以0.96×10^-3mm²/s为阈值诊断HCC的敏感度、特异度分别为84.44%、90.02%。结论 IVIM-DWI有助于鉴别诊断HCC和FNH,其中双指数模型计算的D值诊断效能更高。     

超声造影LI-RADS的临床应用

随着微气泡声学造影剂的发展，超声造影 (Contrast-enhanced ultrasound, CEUS) 能实时连续地观察肝脏局灶性病变的血流灌注情况，显著提高了超声诊断肝细胞癌 (Hepatocellular carcinoma, HCC) 的准确性。为规范和统一CEUS的图像采集和影像报告，便于临床医生和影像科医生的临床交流，美国放射学会 (American College of Radiology, ACR) 于2016年发布了CEUS 肝脏影像及数据报告系统 (Liver Imaging Reporting and Data System, LI-RADS) 指南并在2017年完成了修订, 目前已经在大部分欧洲和亚洲国家和地区广泛使用。本文就CEUS LI-RADS的临床应用作一评述。     

Common pitfalls when using the Liver Imaging Reporting and Data System (LI-RADS): lessons learned from a multi-year experience

The goal of the Liver Imaging Reporting and Data System (LI-RADS) is to standardize the interpretation and reporting of liver observations on contrast-enhanced CT and MR imaging of patients at risk for hepatocellular carcinoma. Although LI-RADS represents a significant achievement in standardization of the diagnosis and management of cirrhotic patients, complexity and caveats to the algorithm may challenge correct application in clinical practice. The purpose of this paper is to discuss common pitfalls and potential solutions when applying LI-RADS in practice. Knowledge of the most common pitfalls may improve the diagnostic confidence and performance when using the LI-RADS system for the interpretation of CT and MR imaging of the liver.

     

MR versus CEUS LI-RADS for Distinguishing Hepatocellular Carcinoma from other Hepatic Malignancies in High-Risk Patients

Distinguishing between other hepatic malignancies (OMs) and hepatocellular carcinoma (HCC) is vital to allow clinicians to determine optimal treatment and assess prognosis in patients at high risk for HCC. This study evaluated the performance of the Liver Imaging Reporting and Data System (LI-RADS) using magnetic resonance imaging (MRI) versus contrast-enhanced ultrasonography (CEUS) for differentiating HCC from OMs in patients at high risk for HCC. This retrospective study consecutively enrolled 106 high-risk patients with HCC and 52 high-risk patients with OMs. Patients underwent both MRI and CEUS, with histologic diagnosis as a reference standard. The diagnostic performance of MR versus CEUS LI-RADS was calculated and compared. The performance of the modified CEUS LI-RADS criteria was also evaluated and compared. Our research found that MRI features significantly differed between patients with OMs and those with HCC (p < 0.05), with sensitivities of 34.6%–69.2% and specificities of 83.0%–95.3% for diagnosing OMs and an LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma sensitivity of 90.4% and specificity of 83.0% for diagnosing OM. CEUS features also significantly differed between patients with OM and HCC (p < 0.05), with sensitivities of 11.5%–96.2% and specificities of 23.6%–100% for diagnosing OMs, and an LR-M sensitivity of 98.1% and specificity of 84.0% for diagnosing OMs. Accuracies of category LR-M did not significantly differ between MR and CEUS LI-RADS (85.4% vs. 88.6%, p = 0.724). After reclassification of category LR-M nodules to category LR-5 if they exhibited clear intratumoral non-enhanced area boundaries and no punched-out appearance before 5 min, accuracy increased from 88.6% to 96.8% for CEUS LR-M and from 84.8% to 91.1% for CEUS LR-5. LR-M accuracies were significantly higher for the modified version of the CEUS LI-RADS than for MR LI-RADS (96.8% vs. 85.4%, respectively, p = 0.04). CEUS LI-RADS and MR LI-RADS can effectively be used to distinguish HCC from OMs. In patients at high risk of HCC, performance may be further improved by using a modified CEUS LI-RADS classification system in which category LR-M lesions are considered LR-5 if they have clear intratumoral non-enhanced area boundaries and do not have a punched-out appearance.     

Hepatocellular nodules in liver cirrhosis: MR evaluation

Liver cirrhosis is a major public health problem worldwide. Common causes of cirrhosis include hepatitis C virus, hepatitis B virus, alcohol consumption, and nonalcoholic steatohepatitis. Cirrhotic livers are characterized by advanced hepatic fibrosis and the development of hepatocellular nodules such as regenerative nodules, dysplastic or neoplastic nodules. Cirrhosis is the strongest predisposing factor for hepatocellular carcinoma (HCC). For example, viral hepatitis is the main risk factor for cirrhosis and is associated with the increased incidence (1%–4% per year) of HCC after development of cirrhosis. Currently, a variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography (PET) are used in noninvasive evaluation of patients with chronic liver disease and suspected HCC. With technological development of MR scanners, MR imaging has emerged as an important imaging modality for assessing cirrhosis and its complications such as HCC. The recent advance in MR is the introduction of faster sequences which have allowed high-quality imaging of the entire liver with high intrinsic soft-tissue contrast, and also multiphasic dynamic MRI that is essential for the detection and characterization of HCC. In addition, functional MRI including diffusion-weighted MRI, MR elastography, and new MR contrast agent with dual function have been investigated for the clinical utility of detection and characterization of HCCs. In this article, we provide an overview of the state-of-the-art MR imaging techniques being used for noninvasive assessment of hepatocellular nodules including conventional dynamic imaging, liver-specific contrast-enhanced MR imaging, diffusion-weighted imaging, MR spectroscopy, and MR elastography.     

Comparison of Contrast-Enhanced Ultrasound versus Contrast-Enhanced Magnetic Resonance Imaging for the Diagnosis of Focal Liver Lesions Using the Liver Imaging Reporting and Data System

The aim of this retrospective study was to evaluate the Liver Imaging Reporting and Data System (LI-RADS) categorization of focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (CE-MRI). A total of 63 patients with 84 FLLs were included in the final study population, after review of the electronic medical records and clinical data. Two trained radiologists evaluated all CEUS and CE-MRI images independently. They assigned a LI-RADS category to each FLL and assessed major features based on CEUS LI-RADS Version 2017 and computed tomography/MRI LI-RADS Version 2018. The generalized estimating equation method was used to compare the diagnostic performance of the LI-RADS algorithm between CEUS and CE-MRI. The sensitivity of LR-5/LR-TIV (tumor in vein) categories for diagnosing hepatocellular carcinoma (HCC) differed significantly between CEUS and CE-MRI (88.9% [40/45], 95% confidence interval [CI]: 76.5%–95.2%), versus 64.4% (29/45; 95% CI: 49.8%–76.8%), p = 0.006; 82.2% (37/45; 95% CI: 68.7%–90.7%), versus 62.2% (28/45; 95% CI: 47.6%–74.9%), p = 0.034. Inter-observer agreement was substantial for assigning LR-5 on both CEUS and CE-MRI. For both reviewers, there was a higher frequency of LR-5 (44.0% vs. 25.0%, p = 0.009; 42.9% vs. 26.2%, p = 0.023) in CEUS compared with CE-MRI. Arterial phase hyper-enhancement (APHE) was less frequently observed on CEUS than on CE-MRI (46.4% vs. 61.9%, p = 0.044). However, the washout appearance was observed more frequently on CEUS than on CE-MRI (50.0% vs. 28.6%, p = 0.004). Inter-observer agreement between the two reviewers on APHE and washout appearance was excellent for both CEUS and CE-MRI. These findings suggest that CEUS had a much higher sensitivity than CE-MRI in the diagnosis of HCC using LI-RADS, and although the frequencies of major features differed, inter-observer agreement between the two reviewers on major features of HCC was excellent for both CEUS and CE-MRI.     

Impact of Revision of the LR-M Criteria on the Diagnostic Performance of Contrast-Enhanced Ultrasound LI-RADS

This study was aimed at revising the LI-RADS M category (LR-M) criteria to improve the diagnostic performance categories LR-5 and LR-M of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) Version 2017. We enrolled 264 patients (264 nodules) with a risk for hepatocellular carcinoma (HCC). The nodules were assigned specific CEUS LI-RADS categories. Washout onset times for all nodules were noted. The diagnostic performance of LR-5 and LR-M was analyzed based on the different early washout criterion for the LR-M category. The positive predictive values in LR-5, LR-4 and LR-3 were 98.6%, 72.2% and 16.7%, respectively, and that for non-HCC malignancies in LR-M was 25.0%. Patients in the LR-M category were reclassified using 45 s as the early washout criterion. LR-5 had higher sensitivity (65.5% vs. 76.2%, p = 0.012) and area under the receiver operating characteristic curve (0.80 vs. 0.85, p = 0.001) for HCC diagnosis after reclassification. LR-M also had higher specificity (71.4% vs. 81.3%, p = 0.010) in diagnosing non-HCC malignancies after reclassification. Our findings suggest CEUS LR-5 is effective for HCC diagnosis. The use of 45 s as the time criterion of early washout for LR-M can improve LR-5 and LR-M performance in the diagnosis of HCC and non-HCC malignancies, respectively.     

Diagnostic performance of contrast-enhanced multidetector computed tomography and gadoxetic acid disodium-enhanced magnetic resonance imaging in detecting hepatocellular carcinoma: direct comparison and a meta-analysis

The purpose of this study was to directly (head-to-head) compare the per-lesion diagnostic performance of contrast-enhanced computed tomography (CT) (also referred to as CT hereafter) and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging (also referred to as MRI hereafter) for the detection of hepatocellular carcinoma (HCC). Studies reporting direct per-lesion comparison data of contrast-enhanced multidetector CT and Gd-EOB-DTPA-enhanced MR imaging that were published between January 2000 and January 2015 were analyzed. The data of each study were extracted. Systematic review, paired meta-analysis, and subgroup analysis were performed. Twelve studies including 627 patients and 793 HCC lesions were analyzed. The sensitivity estimates of MRI and CT were, respectively, 0.86 (95% CI 0.76–0.93) and 0.70 (95% CI 0.58–0.80), with significant difference (P < 0.05). The sensitivity estimates were both 0.94 (95% CI 0.92–0.96) (Chi-square 4.84, degrees of freedom = 1, P > 0.05). In all subgroups, Gd-EOB-DTPA-enhanced MR imaging was more sensitive than multidetector CT for the detection of HCC, and specificity estimates of both tests maintained at a similarly high level in all conditions: sensitivity estimates of both tests were reduced in studies where patients were diagnosed with HCC solely by liver explant or in those where HCC lesions were small (≤2 cm, especially when ≤1 cm). But in all situations, sensitivities of MRI were higher than those of CT with or without significance. Gd-EOB-DTPA-enhanced MR imaging showed better per-lesion diagnostic performance than multidetector CT for the diagnosis of HCC in patients with cirrhosis and in small hepatic lesions.     

Evidence of diagnostic enhancement pattern in hepatocellular carcinoma nodules ≤2 cm according to the AASLD/EASL revised criteria

Purpose

To define the percentage of small (≤2 cm) hepatocellular carcinoma (HCC) nodules showing the diagnostic enhancement pattern at CEUS, computed tomography (CT), and gadobenate dimeglumine (Gd-BOPTA)—enhanced magnetic resonance (MR) imaging.

Methods

42 cirrhotic patients (26 male, 16 female; 67 ± 12 years) with 46 biopsy-proven HCCs ≤2 cm were included. Each HCC was scanned by CEUS, contrast-enhanced CT, and Gd-BOPTA-enhanced MR imaging. Nodule enhancement was evaluated by two readers. Independent analysis was followed by consensual analysis and the proportion of HCCs with the diagnostic enhancement pattern (nodule hyperenhancing on hepatic arterial phase and hypoenhancing on portal venous—late phase) on CEUS, CT, and MR imaging was compared by chi-square test.

Results

Very good inter-reader agreement was observed on hepatic arterial phase and portal venous—late phase: CEUS, k = 0.89 and 0.85; CT, k = 0.91 and 0.88; MR imaging, k = 0.96 and 0.94. CEUS and CT did not differ in the percentage of HCC nodules with a diagnostic enhancement pattern (18/46 and 16/46; P = 0.66), while MR imaging revealed the diagnostic pattern in higher percentage of nodules (29/46; P = 0.012) in comparison to CEUS and CT.

Conclusions

CEUS and contrast-enhanced CT did not differ in the percentage of small HCC nodules with diagnostic enhancement pattern, while Gd-BOPTA-enhanced MR imaging revealed the diagnostic pattern in a higher nodule number in comparison to CEUS and CT.