Pathological considerations of CEUS LI-RADS: correlation with fibrosis stage and tumour histological grade

Objectives To evaluate the influence of pathological factors, such as fibrosis stage and histological grade, on the Liver Imaging Reporting and Data System (LI-RADS) v2017 category of contrast-enhanced ultrasonography (CEUS) in patients with high risk of hepatocellular carcinoma (HCC). Materials and methods Between June 2015 and December 2016, 441 consecutive patients at high risk of HCC with 460 pathologically proven HCCs were enrolled in this retrospective study. All patients underwent a CEUS examination. The major features (arterial phase hyperenhancement, late and mild washout) were assessed, and LI-RADS categories were assigned according to CEUS LI-RADS v2017. CEUS LI-RADS categories and major features were compared in different histological grades and fibrosis stages. Results The CEUS LR-5 category was more frequently assigned in the low-grade group (151/280) than in the high-grade group (66/159) (p = 0.013), whereas the LR-TIV category was more frequently assigned in the high-grade group (36/159) than in the low-grade group (40/280) (p = 0.035). CEUS LI-RADS category was not significantly different among different fibrosis stages (p >= 0.05). Arterial phase hyperenhancement (APHE) and the hepatic fibrosis stage showed a significant correlation in HCCs >= 2 cm and the low-grade group (p = 0.027 and p = 0.003, respectively). No major features of CEUS LI-RADS showed statistically significant differences between the low- and high-grade groups (p >= 0.05). Conclusion Hepatic fibrosis stage can influence APHE but showed no impact on the CEUS LI-RADS classification, whereas the histological grade of HCC influenced the LR-5 and LR-TIV categories.

Automated summary

Pathological factors such as fibrosis stage and histological grade can influence the contrast-enhanced ultrasonography (CEUS) Liver Imaging Reporting and Data System (LI-RADS) classification in patients at high risk of hepatocellular carcinoma. Hepatic fibrosis stage may affect arterial phase hyperenhancement (APHE) but does not impact the CEUS LI-RADS classification, while the histological grade of HCC can influence LR-5 and LR-TIV categories.