LI-RADS for Diagnosing Hepatocellular Carcinoma by Contrast-enhanced US with SonoVue and Sonazoid—A Single Center Prospective Study

Abstract Purpose: To compare the diagnostic performance of two algorithms for HCC diagnosis: SonoVue-CEUS based on CEUS LI-RADS version 2017 and a modified algorithm incorporating Kupffer-phase findings for Sonazoid-CEUS. Materials and Methods: This single center prospective study enrolled high-risk patients for HCC. Each participant underwent same-day SonoVue-CEUS and Sonazoid-CEUS. Each liver observation was assigned two LI-RADS categories according to each algorithm: SonoVue-CEUS LI-RADS SHF and modified Sonazoid-CEUS LI-RADS. For the latter method, observations at least 10 mm with nonrim arterial phase hyperenhancement were upgraded LR-4 to LR-5 if there was no washout with a Kupffer defect and were reassigned LR-M to LR-5 if there was early washout with mild Kupffer defect. The reference standard was pathologic confirmation. Results: Overall, 66 patients (mean age, 61.2 years ± 10.9; 54 male patients, 12 female patients) with 66 observations (mean size, 31mm ± 16) were eventually enrolled. Compared with the SonoVue-CEUS LI-RADS, the results of Sonazoid-CEUS LI-RADS showed significant changes in sensitivity (88% vs. 63%, P＜0.001), accuracy (85% vs. 68%, P＜0.001). There was no significant difference in specificity (71% vs 76%, P =.26). Conclusion: When incorporating Kupffer-phase findings, Sonazoid-CEUS LI-RADS had higher sensitivity without loss of specificity comparing with SonoVue-CEUS LI-RADS. Background: Liver Imaging Reporting and Data System (LI-RADS) was designed for contrast-enhanced US (CEUS) with pure blood pool agents for diagnosis of hepatocellular carcinoma (HCC), such as SonoVue, but Kupffer-cell agents, such as Sonazoid, allow additional lesion characterization in the Kupffer phase yet remain unaddressed.