Optimising contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma diagnosis in non-cirrhotic hepatitis B virus infection patients: incorporating alpha-fetoprotein or adjusting washout criteria.

AIM: To improve the diagnostic performance of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) in non-cirrhotic hepatitis B virus (NC-HBV) patients by integrating serum alpha-fetoprotein (AFP) or adjusting washout thresholds. MATERIALS AND METHODS: A retrospective analysis included 105 pathologically confirmed focal liver lesions in NC-HBV patients. The diagnostic performance of the original CEUS LI-RADS (Criteria 1) was compared with three modified versions: reclassifying LR-M nodules with AFP > 200 ng/mL as LR-5 (Criteria 2), AFP > 400 ng/mL as LR-5 (Criteria 3), and reducing the early washout threshold for LR-M from 60 seconds to 45 seconds (Criteria 4). Sensitivity, specificity, and positive predictive value (PPV) were assessed. RESULTS: Criteria 1 showed high specificity (93.1%) and PPV (95.2%) but low sensitivity (52.6%) for HCC. Criteria 2, 3, and 4 significantly increased sensitivity to 68.4%, 67.1%, and 63.2%, respectively (all P < .05), without significantly reducing specificity or PPV (all P > .05). For non-HCC malignancies, the specificity of revised LR-M increased to 82.8%, 81.6%, and 82.8% with Criteria 2, 3, and 4, respectively, compared to Criterion 1 (69.0%; all P < .01), while sensitivities remained statistically unchanged (all P > .05). CONCLUSION: CEUS LR-5 has high specificity for characterising HCC in NC-HBV patients. Integrating AFP or modifying the early washout threshold can significantly improve the sensitivity of CEUS LR-5 for diagnosing HCC in NC-HBV patients, while maintaining high specificity and PPV.