Modified CEUS LI-RADS With Perfluorobutane in Patients at High-Risk for Hepatocellular Carcinoma: A Systematic Review and Network Meta-Analysis.

Contrast-enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) 2017 version is based on pure-blood pool contrast agent, potentially unsuitable for perfluorobutane contrast agent with the Kupffer phase. This article aimed to compare the diagnostic performance of unmodified CEUS LI-RADS and modified CEUS LI-RADS using perfluorobutane for hepatocellular carcinoma by integrating published and original data from three medical centers. Comparison between unmodified and modified CEUS LI-RADS with perfluorobutane involved ranking the diagnostic odds ratio (DOR) and superiority index (SI) using an ANOVA arm-based model. This meta-analysis included nine studies and our original data, encompassing 1505 patients with 1622 lesions. The summarized sensitivity of the modified CEUS LI-RADS was higher than that of the unmodified version (0.77 [0.72-0.81] vs. 0.70 [0.63-0.76]), while specificity was similar for both (0.86 [0.78-0.91] vs. 0.86 [0.77-0.92]). The general diagnostic performance of the modified CEUS LI-RADS was superior to the unmodified version, indicated by a higher DOR (16.98 [11.65-23.43] vs. 12.51 [8.11-18.44], p = 0.02) and SI (1.59 [1.00-3.00] vs. 0.80 [0.33-1.00], p = 0.02). Modified CEUS LI-RADS may be of better diagnostic performance, offering higher sensitivity without compromising specificity.