An evaluation of high-risk patients with focal liver lesions and negative AFP based on LI-RADS classification criteria of contrast-enhanced ultrasound

Abstract

Abstract: Objective To analyze the clinical value of using contrast-enhanced ultrasound LI-RADS classification criteria to evaluate the high-risk of alpha fetoprotein (AFP) negative focal liver lesions. Methods Between January 2018 and January 2022, 120 patients with high risk of focal liver lesions with negative AFP were admitted to our hospital, with a total of 153 lesions. All patients underwent contrast-enhanced ultrasound examination, and the lesions were classified based on LI-RADS. The pathological examination results were used as the gold standard to analyze the evaluation value of LI-RADS classification criteria for liver focal lesions at high risk of negative AFP. Results 153 lesions were confirmed by histopathology, including 90 HCC, 19 other liver malignant tumors and 44 benign liver lesions. HCC is mainly characterized by arterial phase hyperenhancement (78 cases) and delayed/mild clearance (70 cases); Among other malignant liver tumors, 9 showed arterial phase hyper-enhancement and 8 showed circular enhancement, with contrast agent clearance of 100%, significant clearance of 8, and mild clearance of 11. Benign liver lesions were mainly characterized by equal arterial enhancement (18 cases) and delayed phase no clearance (32 cases). Under the LR-5 classification standard, there were 77 HCCs in 153 lesions, 66 of which were true HCCs, with a positive detection rate of 73.3% (66/90), which was in good agreement with histopathology, and the Kappa value was 0.792. Under the LR-4+5 classification standard, there were 83 HCCs in 153 lesions, 80 of which were true HCCs, with a positive detection rate of 88.9% (80/90), which was consistent with histopathology examination, and the Kappa value was 0.763. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of LR-4+5 classification for AFP negative HCC were 88.9%, 95.2%, 91.5%, 96.4%, and 85.7%, respectively, which were higher than those of 73.3%, 82.5%, 77.1%, 85.7%, 68.4% of LR-5 classification standards (P<0.05). Conclusion The LI-RADS classification standard for contrast-enhanced ultrasound has certain evaluation value for high-risk liver focal lesions with negative AFP. Among them, the LR-4+5 classification standard has excellent diagnostic efficacy and is worth of vigorously promotion and usage in clinical practice.

Key words: Negative alpha fetoprotein, Focal liver lesions, Contrast-enhanced ultrasound, LI-RADS classification

Ma Yu, Lai Shi-feng, Hong Li. An evaluation of high-risk patients with focal liver lesions and negative AFP based on LI-RADS classification criteria of contrast-enhanced ultrasound[J]. Chinese Hepatolgy, 2025, 30(4): 446-448.

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