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Hemangiomas are among the most common benign solid lesions that can occur in the liver. Generally, they occur as a single lesion less than 3 cm diameter, but there are also described cases with multiple or bigger lesions (up to 20 cm). The diagnosis is confirmed by using imaging methods, thus their incidence has increased due to the recent improvement and widespread use of imaging. The aim of this study was to evaluate the usefulness of CEUS in clinical practice. We performed a retrospective study for the year 2021 in the Gastroenterology Department of Emergency County Hospital of Craiova, Romania, including patients with diagnosed hepatic hemangioma. It is based on a group of 35 patients, 12 men and 18 women, ages ranged from 34 to 85 years. There were detected 65 focal liver lesions (21 patients with single lesion, 14 patients with 2 or more lesions) suspected as hemangiomas after performing standard abdominal US, which were further investigated by CEUS and/or contrast-enhanced CT or MRI and diagnosed as hepatic hemangiomas due to the typical enhancement pattern identified, consistent with EFSUMB guidelines. Out of the 35 patients included in our study, 25 had no pre-existing liver damage, 8 had moderate diffuse steatosis and 2 had ethanolic liver cirrhosis. Within standard B-mode US of the 65 lesions, there were found 12 cases (18,5%) with a hypoechoic appearance, 52 cases (80%) with a hyperechoic appearance and 1 case (1,5%) with an isoechoic appearance. None of them showed intralesional vessels at color or power Doppler exam. Out of the 65 FLL, 47 cases (72,3%) were diagnosed as hepatic hemangiomas by CEUS, after presenting typical enhancing pattern: centripetal fill-in in the arterial phase (all 47 cases), partial (20 cases) or complete (27 cases) centripetal filling and sustained enhancement in portal and late phases; 1 case (1,6%) showed no enhancement in any on the vascular phases of CEUS, therefore it was also performed a contrast enhanced CT which confirmed the diagnosis of sclerosed hemangioma (atypical variant); 14 cases (21,5%) were investigated and diagnosed only by contrast-enhanced CT/MRI due to their associated pathology which required detailed investigations (without performing CEUS); 3 cases (4,6%) had typical aspect at standard B-mode US, being diagnosed without the necessity of any other investigations. Contrast enhanced imaging has an unmatched value for HH diagnosis due to their typical enhancement pattern of the contrast agent, therefore CEUS could be considered the first-line investigation in all the patients with suspected hemangioma after performing a standard B-mode US. [ABSTRACT FROM AUTHOR]

CEUS has increased the capability of ultrasonography for the detection of focal liver lesions (FLL). The differential diagnosis between hepatocellular carcinoma (HCC) and other malignant tumors may be limited by similarities in the appearance of CEUS. The aim of this study was to evaluate the role of combination of LR-4 and LR-5 by adding ancillary features (AFs) in the CEUS LI-RADS v2017 algorithm for the diagnosis of definite HCC. This retrospective single- center study included 143 patients with 191 FLL detected by abdominal ultrasound from a total of 823 consecutive patients. The risk factors were liver cirrhosis of any etiology and non-cirrhotic HBV patients. Diagnosis was established either through histopathology or based on CT/MRI scan. CEUS recordings were assessed by an EFSUMB level 3 sonographer, with more than 10 years experience in CEUS and who was blinded to clinical data and to the final diagnosis. All lesions have been categorized according to the CEUS LI-RADS® described by The American College of Radiology scheme. The AFs were taken into account. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. PPV for primitive malignancy (LR-4 + LR-5) was 95.7% (95CI%: 90.7–98%), with 88.07% sensitivity, 89.3% specificity and 88.4% accuracy for HCC (95CI%: 82.8–92.6%). LR4 + LR5 had 81.8% sensitivity for HCCs over 2 cm (n = 127), and 78.57% sensitivity for HCCs less than 2 cm (n = 14). Both sensitivity and accuracy of LR-4 + LR-5 for the diagnosis of definite HCC considerably raised to 88.07% and 88.4%, unlike the sensitivity and accuracy for LR-5 of only 60.45% and 69%, respectively. NPV also improved (73.4% vs. 46.6%), while similar high PPVs (95.7% vs. 96.2%) and quite similar specificity (89.3% vs. 93.6%) were maintained. Higher sensitivity than estimated for the diagnosis of HCCs smaller than 2 cm was achieved for CEUS LR-4 and LR-5. The use of AFs might improve the overarching goal of CEUS LR-5 + LR-4 diagnosis of high specificity for HCC and exclusion of non-HCC malignancy, despite the size of the lesion. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is one of the neoplasms with a growing incidence. Only a limited number of studies evaluated the diagnostic performance of CEUS LI-RADS. Clinical utility of ancillary features (AFs) in CEUS LI-RADS is yet to be established. We assessed the diagnostic yield of CEUS LI-RADS and AFs in HCC. To our knowledge, this is the first blind study of CEUS application in assessing focal liver lesions (FLL) by using the LI-RADS algorithm and AFs. We retrospectively included patients with risk factors for HCC with newly diagnosed FLL, hospitalized between January 2016 and December 2019 in the Gastroenterology Department of Emergency County Hospital of Craiova, Romania. All lesions have been categorized according to the CEUS LI-RADS v2017 by an experienced sonographer blinded to clinical data and to the final diagnosis. CEUS AFs in favor of benignity were size reduction or stability >2 years of the tumor. The malignancy aspects were: definite growth, nodule in nodule architecture and mosaic architecture, favoring HCC in particular. Diagnostic accuracy of CEUS was calculated. From a total of 143 patients with 191 FLL, AFs favoring HCC were observed in 19.8% cases as hypoechoic rim and in 16.7% cases as nodule in nodule architecture. From the total of 141 HCC cases, 118 of them (83.6%) were correctly classified as HCC diagnosis, as follows: 81 tumors (57.4%)—definitely HCC (LR-5) and 37 tumors (26.2%)—probably HCC (LR-4). In 13 cases (9.21%), CEUS characteristics indicated malignant lesions, but not necessarily HCC (LR-M); 3 cases (2.12%) were classified as intermediate probability of malignancy (LR-3); none of them was incorrectly diagnosed as benign. The LR-5 category was 96.2% (95% CI: 89.4–98.7%) predictive (PPV) of HCC, with one case of misdiagnosis for cholangiocarcinoma. CEUS LR-5 sensitivity for HCC was 60.4% and specificity was 93.6%. Regarding the LR-4 category, PPV was 94.8%, with only 26.2% sensitivity, whereas for LR-3 the PPV was 41.02%, with only 2% sensitivity. CEUS LIRADS algorithm including AFs remains an excellent diagnostic tool for HCC. [ABSTRACT FROM AUTHOR]

Clinical utility of ancillary features (AFs) in contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®) is yet to be established. In this study, we assessed the diagnostic yield of CEUS LI-RADS and AFs in hepatocellular carcinoma (HCC). We retrospectively included patients with risk factors for HCC and newly diagnosed focal liver lesions (FLL). All lesions have been categorized according to the CEUS LI-RADS v2017 by an experienced sonographer blinded to clinical data and to the final diagnosis. From a total of 143 patients with 191 FLL, AFs favoring HCC were observed in 19.8% cases as hypoechoic rim and in 16.7% cases as nodule-in nodule architecture. From the total of 141 HCC cases, 83.6% were correctly classified: 57.4%- LR-5 and 26.2%- LR-4. In 9.21% cases, CEUS indicated LR-M; 2.12% cases- LR-3. The LR-5 category was 96.2% predictive (PPV) of HCC. LR-5 had 60.4% sensitivity and 93.6% specificity. PPV for primitive malignancy (LR-4 + LR-5) was 95.7%, with 88% sensitivity, 89.3% specificity and 88.4% accuracy for HCC. LR-4 category had 94.8% PPV and 26.2% sensitivity. CEUS LR4 + LR5 had 81,8% sensitivity for HCCs over 2 cm and 78.57% sensitivity for smaller HCCs. CEUS LR-5 remains an excellent diagnostic tool for HCC, despite the size of the lesion. The use of AFs might improve the overarching goal of LR-5 + LR-4 diagnosis of high specificity for HCC and exclusion of non-HCC malignancy. [ABSTRACT FROM AUTHOR]