Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma – A Prospective Multicenter DEGUM Study

Schellhaas B, Bernatik T, Bohle W, Borowitzka F, Chang J, Dietrich CF, Dirks K, Donoval R, Drube K, Friedrich-Rust M, Gall C, Gittinger F, Gutermann M, Haenle MM, von Herbay A, Ho CH, Hochdoerffer R, Hoffmann T, Hüttig M, Janson C, Jung EM, Jung N, Karlas T, Klinger C, Kornmehl A, Kratzer W, Krug S, Kunze G, Leitlein J, Link A, Lottspeich C, Marano A, Mauch M, Moleda L, Neesse A, Petzold G, Potthoff A, Praktiknjo M, Rösner KD, Schanz S, Schultheiß M, Sivanathan V, Stock J, Thomsen T, Vogelpohl J, Vogt C, Wagner S, Wiegard C, Wiesinger I, Will U, Ziesch M, Zimmermann P, Strobel D (2020)

Publication Type: Journal article

Publication year: 2020


DOI: 10.1055/a-1198-4874


Background This prospective multicenter study funded by the DEGUM assesses the diagnostic accuracy of standardized contrast-enhanced ultrasound (CEUS) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. Methods Patients at high risk for HCC with a histologically proven focal liver lesion on B-mode ultrasound were recruited prospectively in a multicenter approach. Clinical and imaging data were entered via online entry forms. The diagnostic accuracies for the noninvasive diagnosis of HCC were compared for the conventional interpretation of standardized CEUS at the time of the examination (= CEUS on-site) and the two CEUS algorithms ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) and CEUS LI-RADS (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System). Results 321 patients were recruited in 43 centers; 299 (93.1 %) had liver cirrhosis. The diagnosis according to histology was HCC in 256 cases, and intrahepatic cholangiocarcinoma (iCCA) in 23 cases. In the subgroup of cirrhotic patients (n = 299), the highest sensitivity for the diagnosis of HCC was achieved with the CEUS algorithm ESCULAP (94.2 %) and CEUS on-site (90.9 %). The lowest sensitivity was reached with the CEUS LI-RADS algorithm (64 %; p < 0.001). However, the specificity of CEUS LI-RADS (78.9 %) was superior to that of ESCULAP (50.9 %) and CEUS on-site (64.9 %; p < 0.001). At the same time, the negative predictive value (NPV) of CEUS LI-RADS was significantly inferior to that of ESCULAP (34.1 % vs. 67.4 %; p < 0.001) and CEUS on-site (62.7 %; p < 0.001). The positive predictive values of all modalities were high (around 90 %), with the best results seen for CEUS LI-RADS and CEUS on-site. Conclusion This is the first multicenter, prospective comparison of standardized CEUS and the recently developed CEUS-based algorithms in histologically proven liver lesions in cirrhotic patients. Our results reaffirm the excellent diagnostic accuracy of CEUS for the noninvasive diagnosis of HCC in high-risk patients. However, on-site diagnosis by an experienced examiner achieves an almost equal diagnostic accuracy compared to CEUS-based diagnostic algorithms.

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Involved external institutions

Universitätsklinikum Bonn DE Germany (DE) Universitätsklinikum Göttingen DE Germany (DE) Städtisches Klinikum Braunschweig DE Germany (DE) Universitätsklinikum Regensburg DE Germany (DE) SRH Wald-Klinikum Gera DE Germany (DE) Klinikum St. Elisabeth Straubing GmbH DE Germany (DE) Klinikum Barnim GmbH, Werner Forßmann Krankenhaus DE Germany (DE) Albert-Ludwigs-Universität Freiburg DE Germany (DE) Isarklinikum (Isar Kliniken GmbH) DE Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz DE Germany (DE) Westküstenkliniken Brunsbüttel und Heide gGmbH DE Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) St. Josef Krankenhaus DE Germany (DE) Universitätsklinikum Ulm DE Germany (DE) Kliniken Landkreis Heidenheim gGmbH DE Germany (DE) Klinikum Weiden DE Germany (DE) Universitätsklinikum Magdeburg A.ö.R. DE Germany (DE) Klinikum am Steinenberg Reutlingen DE Germany (DE) Caritas-Krankenhaus Bad Mergentheim gemeinnützige GmbH DE Germany (DE) Regionale Kliniken Holding RKH DE Germany (DE) Universitätsklinikum Halle (Saale) DE Germany (DE) Universitätsklinikum Tübingen DE Germany (DE) Deutsches Rotes Kreuz e.V. (DRK) DE Germany (DE) Lausitzer Seenland Klinikum GmbH DE Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School DE Germany (DE) Hufeland Klinikum DE Germany (DE) Universitätsklinikum Leipzig DE Germany (DE) Klinikum Stuttgart DE Germany (DE) Kreisklinik Ebersberg DE Germany (DE) Universitätsmedizin Rostock DE Germany (DE) Allgemeines Krankenhaus Celle DE Germany (DE) Vincentius-Diakonissen-Kliniken DE Germany (DE) Evangelisches Krankenhaus Hamm DE Germany (DE) Städtisches Klinikum Karlsruhe DE Germany (DE) Klinikum der Universität München DE Germany (DE) Rems-Murr-Kliniken DE Germany (DE)

How to cite


Schellhaas, B., Bernatik, T., Bohle, W., Borowitzka, F., Chang, J., Dietrich, C.F.,... Strobel, D. (2020). Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma – A Prospective Multicenter DEGUM Study. Ultraschall in der Medizin.


Schellhaas, Barbara, et al. "Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma – A Prospective Multicenter DEGUM Study." Ultraschall in der Medizin (2020).

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