Abstract
Rationale and objectives
We aimed to validate and optimize the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for diagnosing small hepatocellular carcinoma (sHCC; ≤ 30 mm) in a Chinese expanded high-risk population: a viral-related liver disease or cirrhosis (VC) group, and a non-VC group with non-cirrhotic, non-viral liver disease, including alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease.Materials and methods
This multicenter study included 856 liver nodules (≤ 30 mm) from 815 patients, divided into retrospective derivation and prospective validation cohorts. CEUS LI-RADS v2017 was applied, then optimized by (1) tightening the early-washout cutoff from 20 ng/mL, reclassifying LR-4/LR-M nodules as LR-5++. Standard and optimized criteria were compared using accuracy, sensitivity, specificity, and positive predictive value (PPV).Results
Across cohorts, standard LR-5 showed high specificity (87.67-93.01%) but suboptimal sensitivity (57.69-64.41%). In the validation cohort, LR-5++ significantly improved sensitivity from 57.69% to 71.43% (P Conclusion
A study-derived modification of CEUS LI-RADS incorporating AFP >20 ng/mL (LR-5++) improved diagnostic performance for sHCC in this cohort, addressing the limitated sensitivity of the standard algorithm.