To compare the diagnostic value of the American College of Radiology contrast-enhanced ultrasound liver imaging reporting and data system (ACR CEUS LI-RADS) and the World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) guidelines for hepatocellular carcinoma (HCC) in high-risk patients.

From March 2018 to December 2020, 319 patients (334 lesions) with a high risk of HCC at the Second Affiliated Hospital Zhejiang University School of Medicine were analyzed. CEUS videos of 334 lesions were interpreted according to the CEUS LI-RADS 2017 edition and WFUMB-EFSUMB classification criteria. Using surgery or biopsy histopathology, clinical diagnosis, and follow-up results as reference standards, the diagnostic efficacy of each classification of ACR CEUS LI-RADS for HCC was analyzed. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the ROC curve of ACR CEUS LI-RADS LR-5 and WFUMB-EFSUMB criteria in the diagnosis of HCC were calculated and compared by the chi-square test and DeLong's test. The area under the ROC curve of the combined diagnosis was also calculated and compared with that of either of them.

Of the 334 liver lesions included, according to the ACR CEUS LI-RADS classification, there were 114 nodules in LR-5 category, 25 in LR-4, 12 in LR-3, and 162 in LR-M; their positive predictive values for the diagnosis of HCC were 93.9%, 40.0%, 16.7%, and 24.7%, respectively. The sensitivity and specificity of ACR CEUS LI-RADS LR-5 and WFUMB-EFSUMB in the diagnosis of HCC were 66.9% vs 83.8% and 96.0% vs 73.0%, respectively, and the differences were statistically significant (χ²=25.037 and 38.025; P＜0.001). There was no significant difference in the diagnostic accuracy of the two criteria (82.0% vs 78.1%, χ²=1.352, P=0.245). The areas under the ROC curve were 0.814 and 0.784, respectively, and the difference was not statistically significant (P=0.161). The area under the ROC curve of the combined diagnosis of the two was 0.857, which was significantly higher than that of either of them (P=0.001 and <0.001, respectively).

Both ACR CEUS LI-RADS and WFUMB-EFSUMB criteria have high diagnostic value for HCC in high-risk patients. The diagnostic efficacy of ACR CEUS LI-RADS LR-5 and WFUMB-EFSUMB is similar. However, the information provided by the two criteria is different, with ACR CEUS LI-RADS LR-5 having a higher specificity and WFUMB-EFSUMB having a higher sensitivity. The two criteria can complement each other to a certain extent.