通过对比增强超声（CEUS）肝脏成像报告和数据系统（LI-RADS）中的摄食动脉（FA）特征是否可以在鉴别小肝细胞癌（HCC）与癌前病变时发挥作用进行调查。自2017年6月至2021年5月，共有347位接受CEUS检查的患者入选，共351个癌前肝病变或小HCC。两位独立的放射科医生为所有病变分配LI-RADS分类，并评估FA特征的存在，该特征被用作升级或降级LI-RADS分类的辅助特征。根据准确性、敏感性、特异性、阳性预测值和阴性预测值评估了CEUS LI-RADS在有无FA特征的情况下的诊断性能。发现FA特征在HCC（85.54%，p < 0.001）中的存在比再生结节（RNs，29.73%）、低级别畸形结节（LGDNs，33.33%）和高级别畸形结节（HGDNs，55.26%）中更为普遍。此外，肝结节中存在动脉期强化（APHE）、洗出（WO）和FA与GPC-3和Ki-67的表达水平较高的组相比（p < 0.001）。调整后，HCC的LR-5的敏感性和准确性分别从68.67%（95%CI: 62.46%，74.30%）提高到77.51%（95%CI: 71.72%，82.44%）和从69.23%（95%CI: 64.11%，74.02%）提高到73.79%（95%CI: 68.86%，78.31%）。FA特征是区分小HCC和癌前病变的有价值特征，并可以作为CEUS LI-RADS的可能辅助特征，这一点得到了生物标记的支持。摄食动脉的存在是区分HCC和癌前病变的有价值的影像特征。将这一特征纳入CEUS LI-RADS可以增强其诊断能力。- 摄食动脉在HCC中比在再生结节、低级别畸形结节和高级别畸形结节中更常见。- 摄食动脉特征是CEUS LI-RADS区分再生结节、低级别畸形结节、高级别畸形结节和HCC的有价值辅助特征。- 摄食动脉的存在、动脉期强化和洗出与GPC-3阳性表达和Ki-67高表达相关联，而无这些特征的组别则不具备这种关联。© 2023. 作者(们)在Europe Society of Radiology的独家许可下。

To investigate whether the feeding artery (FA) feature can aid in discriminating small hepatocellular carcinoma (HCC) using the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) from precancerous lesions.Between June 2017 and May 2021, a total of 347 patients with 351 precancerous liver lesions or small HCCs who underwent CEUS were enrolled. Two independent radiologists assigned LI-RADS categories to all lesions and assessed the presence of the FA feature, which was used as an ancillary feature to either upgrade or downgrade the LI-RADS category. The diagnostic performance of CEUS LI-RADS, both with and without the FA feature, was evaluated based on accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.The FA feature was found to be more prevalent in HCC (85.54%, p < 0.001) than in regenerative nodules (RNs, 29.73%), low-grade dysplastic nodules (LGDNs, 33.33%), and high-grade dysplastic nodules (HGDNs, 55.26%). Furthermore, the presence of arterial phase hyperenhancement (APHE), washout (WO), and FA in liver nodules was associated with a higher expression of GPC-3 and Ki-67 compared to the group without these features (p < 0.001). After adjusting, the sensitivity and accuracy of LR-5 for HCC improved from 68.67% (95%CI: 62.46%, 74.30%) to 77.51% (95%CI: 71.72%, 82.44%) and from 69.23% (95%CI: 64.11%, 74.02%) to 73.79% (95%CI: 68.86%, 78.31%), respectively.The FA feature is a valuable feature for distinguishing small HCC and precancerous lesions and could be added as a possible ancillary feature in CEUS LI-RADS which was backed up by biomarkers.The presence of a feeding artery is a valuable imaging feature in the differentiation of HCC and precancerous lesions. Incorporating this characteristic in the CEUS LI-RADS can enhance the diagnostic ability.• Feeding artery is more frequent in HCC than in regenerative nodules, low-grade dysplastic nodules, and high-grade dysplastic nodules. • Feeding artery feature is a valuable ancillary feature for CEUS LI-RADS to differentiate regenerative nodules, low-grade dysplastic nodules, high-grade dysplastic nodules, and HCC. • The existence of feeding artery, arterial phase hyperenhancement, and washout is associated with more GPC-3 positive expression and higher Ki-67 expression than the group without these features.© 2023. The Author(s), under exclusive licence to European Society of Radiology.