Objective To evaluate the performance of contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) LR-5 in the diagnosis of hepatocellular carcinoma (HCC). Methods The clinical research reports with the application of CEUS LI-RADS in the diagnosis of HCC were collected from PubMed,Embase,Cochrane Library,CNKI,and Wanfang Data from inception to November 14,2021.Two researchers respectively screened the literature and extracted relevant information.The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was used to evaluate the quality of all the included articles.RevMan 5.4,Meta disc 1.4,and Stata 16.0 were employed to analyze the diagnostic performance of LR-5 for HCC in high-risk patients. Results Twenty original studies were included,involving a total of 6131 lesions,of which 5142 were HCC.The results of meta-analysis showed that the LR-5 in CEUS LI-RADS for diagnosing HCC in the high-risk population had the overall sensitivity of 0.72 (95%CI=0.66-0.77),the overall specificity of 0.93 (95%CI=0.87-0.96),the overall positive likelihood ratio of 9.89 (95%CI=5.31-18.41),the overall negative likelihood ratio of 0.30 (95%CI=0.25-0.37),and the area under the summary receiver operating characteristic curve of 0.88 (95%CI=0.85-0.91).There was heterogeneity among the included studies (I²=95.31,P<0.001).The funnel plot indicated the existence of publication bias (P=0.04). Conclusion The CEUS LI-RADS can effectively diagnose HCC in high-risk patients based on the LR-5 criteria.
Humans ; Carcinoma, Hepatocellular/diagnostic imaging* ; Liver Neoplasms/diagnostic imaging* ; Diagnostic Imaging ; Ultrasonography

Various imaging examinations, such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) have played important roles in the evaluation of hepatocellular carcinoma (HCC). Recent advances in US include contrast-enhanced examinations, fusion imaging, and elastography. For CT, various radiation reduction techniques as well as perfusion imaging and dual-energy examination techniques have been developed. For MRI, hepatocyte-specific contrast-enhanced imaging improved the accuracy of examinations by detection of smaller tumors and better characterization of equivocal lesions. Recent MRI developments also include diffusion-weighted imaging, perfusion imaging, and MR elastography. Newer imaging techniques will increase the roles of imaging examinations in the evaluation of HCC.
Carcinoma, Hepatocellular* ; Diagnostic Imaging* ; Elasticity Imaging Techniques ; Magnetic Resonance Imaging ; Perfusion Imaging ; Ultrasonography

Biological behavior is a hot issue in hepatocellular carcinoma (HCC) study. Positron emission tomography (PET), a biological imaging technique, has been widely applied in many types of tumors. It is capable of noninvasive detection of biological behavior. Different radiotracers provide different information of HCC, including glucose/lipid metabolism, DNA synthesis, and apoptosis. In addition, radiotracer uptake relates to biological and clinical prognostic markers. In this article we review the application of several existing and novel radiotracers in PET in HCC study.
Animals ; Carcinoma, Hepatocellular ; diagnostic imaging ; Fluorodeoxyglucose F18 ; Humans ; Liver Neoplasms ; diagnostic imaging ; Positron-Emission Tomography ; methods

Carcinoma, Hepatocellular ; diagnostic imaging ; radiotherapy ; therapy ; Humans ; Liver Neoplasms ; diagnostic imaging ; radiotherapy ; therapy ; Ultrasonography

OBJECTIVETo perform a meta-analysis of contrast-enhanced ultrasound (CEUS) as a diagnostic tool for small hepatocellular carcinoma (HCC) in patients with cirrhosis.

METHODSA computer-based retrieval system was first used to identify reports on the diagnostic efficacy of CEUS for small HCC in patients with cirrhosis that were published between 1995 and April 2012 in the following literature databases: Medline, PubMed, Foreign Medical Journal Service (FMJS), China National Knowledge Infrastructure (CNKI), VIP Journal Integration Platform (VJIP), Wanfang Chinese Periodical Database, and Chinese Biomedicine Database (CBM). Two investigators, working independently, then selected cases from the relevant based upon specific inclusion and exclusion criteria. The extracted data was subjected to quality assessment of diagnostic accuracy studies (QUADAS). The MetaDisc version 1.4 software was used to conduct meta-analyses.

RESULTSSix studies, involving 380 lesions detected by various contrast mediums, were selected for analysis. Diagnosis of small HCC in patients with cirrhosis by CEUS based on Sonovue and Levovist had pooled sensitivities of 0.73 (95% confidence interval (CI): 0.67-0.79) and 0.76 (95% CI: 0.60-0.89), pooled specificities of 0.89 (95% CI: 0.81-0.94) and 0.79 (95% CI: 0.61-0.91), pooled positive likelihood ratios of 6.53 (95% CI: 2.74-15.52) and 3.60 (95% CI: 1.89-6.85), pooled negative likelihood ratios of 0.26 (95% CI: 0.13-0.54) and 0.21 (95% CI: 0.02-2.63), and pooled diagnostic odds ratios of 27.50 (95% CI: 7.99-94.72) and 25.74 (95% CI: 5.30-125.04), respectively. The area under the curve of the summary receiving operating characteristic (SROC) of CEUS based on Sonovue was 0.9252 and the Q* index was 0.8595.

CONCLUSIONCEUS is a valuable diagnostic tool for small HCC in cirrhotic patients.

Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Contrast Media ; Humans ; Liver Cirrhosis ; complications ; diagnostic imaging ; Liver Neoplasms ; complications ; diagnostic imaging ; Ultrasonography

In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: = 125; validation dataset, = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.
Carcinoma, Hepatocellular ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnostic imaging ; Magnetic Resonance Imaging ; Neoplasm Grading ; methods ; ROC Curve

Carcinoma, Hepatocellular ; diagnosis ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnosis ; diagnostic imaging ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

Carcinoma, Hepatocellular ; blood supply ; diagnostic imaging ; Humans ; Liver Neoplasms ; blood supply ; diagnostic imaging ; Microvessels ; diagnostic imaging ; Neovascularization, Pathologic ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

Hepatocellular carcinoma (HCC) is one of the most common malignancies and is a major cause of cancer-related mortalities worldwide (Forner et al., 2018; He et al., 2023). Sarcopenia is a syndrome characterized by an accelerated loss of skeletal muscle (SM) mass that may be age-related or the result of malnutrition in cancer patients (Cruz-Jentoft and Sayer, 2019). Preoperative sarcopenia in HCC patients treated with hepatectomy or liver transplantation is an independent risk factor for poor survival (Voron et al., 2015; van Vugt et al., 2016). Previous studies have used various criteria to define sarcopenia, including muscle area and density. However, the lack of standardized diagnostic methods for sarcopenia limits their clinical use. In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) renewed a consensus on the definition of sarcopenia: low muscle strength, loss of muscle quantity, and poor physical performance (Cruz-Jentoft et al., 2019). Radiological imaging-based measurement of muscle quantity or mass is most commonly used to evaluate the degree of sarcopenia. The gold standard is to measure the SM and/or psoas muscle (PM) area using abdominal computed tomography (CT) at the third lumbar vertebra (L3), as it is linearly correlated to whole-body SM mass (van Vugt et al., 2016). According to a "North American Expert Opinion Statement on Sarcopenia," SM index (SMI) is the preferred measure of sarcopenia (Carey et al., 2019). The variability between morphometric muscle indexes revealed that they have different clinical relevance and are generally not applicable to broader populations (Esser et al., 2019).
Humans ; Aged ; Sarcopenia/diagnostic imaging* ; Carcinoma, Hepatocellular/diagnostic imaging* ; Muscle, Skeletal/diagnostic imaging* ; Deep Learning ; Prognosis ; Radiomics ; Liver Neoplasms/diagnostic imaging* ; Retrospective Studies

Hepatocellular carcinoma (HCC) frequently occurs in association with liver cirrhosis, as chronic liver disease is one of the most important factors in carcinogenesis. In addition to HCCs, recent reports of pathologic studies of resected specimens from cirrhotic liver describe associated small nodular lesions such as regenerative nodule, dysplastic nodule (adenomatous hyperplasia), and dysplastic nodule with subfocus of HCC (early HCC). In hepatocarcinogenesis of the cirrhotic liver, a regenerative nodule might be the first step in the development of HCC, going through phases of dysplastic nodule, early HCC and early advanced HCC in a multistep fashion. Fortunately, recent advances in various imaging techniques have facilitated the verification of these nodules. In this review, new nomenclature of small hepatocellular nodules, and detection and characterization of hepatic nodules in carcinogenesis with various imaging techniques are described with focus on the premalignant lesions and early stage of HCC. In addition, the efficacy of various imaging techniques for diagnosing them is discussed. Although the terms and definitions of these nodules are still variable and controversial, familiarity with the concept of these borderline lesions is important.
Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/diagnosis* ; Carcinoma, Hepatocellular/complications ; Diagnostic Imaging*/methods ; Human ; Liver Cirrhosis/pathology ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/complications ; Patient Care Management ; Terminology