Contrast-enhanced ultrasound Liver Imaging Reporting and Data System: Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

Figure 1  Flow chart of the study.

Figure 2 Examples of different contrast-enhanced ultrasound Liver Imaging Reporting and Data System classes. A: Contrast-enhanced ultrasound (CEUS) LR-M. Notice rim arterial phase hyperenhancement and early washout, before 60 s; B: CEUS LR-5. Notice homogeneous arterial phase hyperenhancement, isoenhancement in portal phase, and mild washout in the late phase; C: CEUS LR-4. Notice homogeneous arterial phase hyperenhancement and isoenhancement in both portal and late phases; D: CEUS LR-3 iso-iso. Notice isoenhancement in all phases; E: CEUS LR-3 hypo-hypo. Notice hypoenhancement in all phases. The arrows show the target lesion.

Figure 3  Absolute frequency (n) of malignancies and benign lesions in LR-3 nodules and LR-3 subgroups with different contrast-enhanced ultrasound patterns.

Figure 4 Bangdiwala’s agreement charts of the Contrast-enhanced ultrasound Liver Imaging Reporting and Data System class assignments between different raters. In the case of perfect agreement, the k rectangles are represented by perfect squares and the shaded squares determined by the diagonal cell entries are exactly equal to the rectangles; lesser agreement is visualized by comparing the area of the blackened squares to the area of the rectangles. A: Agreement chart between the two internal raters (1 and 2), with the exclusion of LR-1 and LR-2 classes due to their rarity (n = 505); B-D: Agreement charts among the three raters from different centres (2, 3, and 4) for the subgroup of 50 nodules. We list the agreement charts between raters 2 and 3 (B), between raters 2 and 4 (C), and between raters 3 and 4 (D).