Diagnostic value of contrast-enhanced ultrasound in serum biomarker negative hepatocellular carcinoma and colorectal cancer liver metastasis

Purpose To explore the ultrasound features and the diagnostic values of CEUS LI-RADS and World Federation for Ultrasound in Medicine (WFUMB) - European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) criteria in serum biomarker negative hepatocellular carcinoma (HCC) and colorectal cancer liver metastasis (CRLM). Methods A total of 161 patients with pathologically diagnosed alpha-fetoprotein (AFP)-negative HCC and carcinoembryonic antigen (CEA)-negative CRLM were retrospectively enrolled, including 101 HCC patients and 60 CRLM patients. The clinical characteristics and ultrasound characteristics of all cases were analyzed and lesions were categorized via two criteria. Results The rate of HBV infection in HCC patients was higher than CRLM patients ( P < 0.001). For the liver parenchyma, the rate of liver cirrhosis and liver steatosis in HCC patients were both higher than CRLM patients ( P < 0.001 and P = 0.048, respectively). On CEUS, HCC lesions depicted higher rate of arterial phase hyperenhancement (APHE), mild washout and later wash-out onset, while rim-hyperenhancement, marked washout and earlier wash-out onset were more frequently observed in CRLM lesions. For diagnosing HCC, the sensitivity, specificity and accuracy of CEUS LR-5 were 55.4%, 93.3% and 69.6%, respectively, and of WFUMB-EFSUMB criteria were 87.1%, 73.3% and 82.0%, respectively. For diagnosing CRLM, the sensitivity, specificity and accuracy of CEUS LR-M were 100.0%, 63.4% and 77.0%, respectively, and of WFUMB-EFSUMB criteria were 76.7%, 94.1% and 87.6%, respectively. Conclusion In patients with serum biomarker negative HCC and CRLM, both CEUS LI-RADS and WFUMB-EFSUMB criteria have each advantages and have high application value.