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Liu Y, Xiao Y, Ni X, Huang P, Wu F, Zhou C, Xu J, Zeng M, Yang C. Value of magnetic resonance imaging for diagnosis of LR‑3 and LR-4 lesions coexisting with hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:2629-2638. [PMID: 38834779 DOI: 10.1007/s00261-024-04338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To explore which preoperative clinical data and conventional magnetic resonance imaging (MRI) features may indicate the presence of hepatocellular carcinoma (HCC) in HCC patients coexisting with LR-3 and LR-4 lesions. METHODS HCC Patients coexisting with LR-3 and LR-4 lesions who participated in a prospective clinical trial (XX) were included in this study. Two radiologists independently assessed the preoperative MRI features and each lesion was assigned according to the liver imaging reporting and data system (LI-RADS). The preoperative clinical data were also evaluated. The relative values of these parameters were assessed as potential predictors of HCC for coexisting LR-3 and LR-4 lesions. RESULTS We enrolled 102 HCC patients (58.1 ± 11.5 years; 84.3% males) coexisting with 110 LR-3 and LR-4 lesions (HCCs group [n = 66]; non-HCCs group [n = 44]). The presence of restricted diffusion (OR: 18.590, p < 0.001), delayed enhancement (OR: 0.113, p < 0.001), and mild-moderate T2 hyperintensity (OR: 3.084, p = 0.048) were found to be independent predictors of HCC diagnosis. The sensitivity and specificity of the above independent variables for the diagnosis of HCC ranged from 66.7 to 80.3% and 56.8 to 88.6%, respectively. ROC analysis showed that, in discriminating HCC, the AUCs of the above factors were 0.777, 0.686, and 0.670, respectively. Combining these three findings for the prediction of HCC resulted in a specificity greater than 97%, and the AUC further increased to 0.874. CONCLUSION The presence of restricted diffusion, delayed enhancement, and mild-moderate T2 hyperintensity can be useful features for risk stratification of coexisting LR-3 and LR-4 lesions in HCC patients. Trial registration a prospective clinical trial (ChiCTR2000036201).
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Affiliation(s)
- Yang Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing University Medical School, No. 1 Lijiang Road, Suzhou, 215153, Jiangsu, China
| | - Yuyao Xiao
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaoyan Ni
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Peng Huang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Fei Wu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Changwu Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Jianming Xu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing University Medical School, No. 1 Lijiang Road, Suzhou, 215153, Jiangsu, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China.
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Xuhui District, No. 180 Fenglin Road, Shanghai, 200032, China.
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Zhang ZX, Xv H, Du YN, Lv ZB, Yang ZH. Optimizing LI-RADS: ancillary features screened from LR-3/4 categories can improve the diagnosis of HCC on MRI. BMC Gastroenterol 2024; 24:117. [PMID: 38515017 PMCID: PMC10956370 DOI: 10.1186/s12876-024-03201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To determine the high-efficiency ancillary features (AFs) screened from LR-3/4 lesions and the HCC/non-HCC group and the diagnostic performance of LR3/4 observations. MATERIALS AND METHODS We retrospectively analyzed a total of 460 patients (with 473 nodules) classified into LR-3-LR-5 categories, including 311 cases of hepatocellular carcinoma (HCC), 6 cases of non-HCC malignant tumors, and 156 cases of benign lesions. Two faculty abdominal radiologists with experience in hepatic imaging reviewed and recorded the major features (MFs) and AFs of the Liver Imaging Reporting and Data System (LI-RADS). The frequency of the features and diagnostic performance were calculated with a logistic regression model. After applying the above AFs to LR-3/LR-4 observations, the sensitivity and specificity for HCC were compared. RESULTS The average age of all patients was 54.24 ± 11.32 years, and the biochemical indicators ALT (P = 0.044), TBIL (P = 0.000), PLT (P = 0.004), AFP (P = 0.000) and Child‒Pugh class were significantly higher in the HCC group. MFs, mild-moderate T2 hyperintensity, restricted diffusion and AFs favoring HCC in addition to nodule-in-nodule appearance were common in the HCC group and LR-5 category. AFs screened from the HCC/non-HCC group (AF-HCC) were mild-moderate T2 hyperintensity, restricted diffusion, TP hypointensity, marked T2 hyperintensity and HBP isointensity (P = 0.005, < 0.001, = 0. 032, p < 0.001, = 0.013), and the AFs screened from LR-3/4 lesions (AF-LR) were restricted diffusion, mosaic architecture, fat in mass, marked T2 hyperintensity and HBP isointensity (P < 0.001, = 0.020, = 0.036, < 0.001, = 0.016), which were not exactly the same. After applying AF-HCC and AF-LR to LR-3 and LR-4 observations in HCC group and Non-HCC group, After the above grades changed, the diagnostic sensitivity for HCC were 84.96% using AF-HCC and 85.71% using AF-LR, the specificity were 89.26% using AF-HCC and 90.60% using AF-LR, which made a significant difference (P = 0.000). And the kappa value for the two methods of AF-HCC and AF-LR were 0.695, reaching a substantial agreement. CONCLUSION When adjusting for LR-3/LR-4 lesions, the screened AFs with high diagnostic ability can be used to optimize LI-RADS v2018; among them, AF-LR is recommended for better diagnostic capabilities.
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Affiliation(s)
- Zi-Xin Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hui Xv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan-Ni Du
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Bin Lv
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Chernyak V. Up-to-Date Role of Liver Imaging Reporting and Data System in Hepatocellular Carcinoma. Surg Oncol Clin N Am 2024; 33:59-72. [PMID: 37945145 DOI: 10.1016/j.soc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This article overviews Liver Imaging Reporting and Data System (LI-RADS), a system that standardizes techniques, interpretation and reporting of imaging studies done for hepatocellular carcinoma surveillance, diagnosis, and locoregional treatment response assessment. LI-RADS includes 4 algorithms, each of which defines ordinal categories reflecting probability of the assessed outcome. The categories, in turn, guide patient management. The LI-RADS diagnostic algorithms provide diagnostic criteria for the entire spectrum of lesions found in at-risk patients. In addition, the use of LI-RADS in clinical care improves clarity of communication between radiologists and clinicians and may improve the performance of inexperienced users to the levels of expert liver imagers.
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Affiliation(s)
- Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
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Jang HJ, Choi SH, Choi SJ, Choi WM, Byun JH, Won HJ, Shin YM. LI-RADS version 2018 for hepatocellular carcinoma < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging. Eur Radiol 2023; 33:5792-5800. [PMID: 37017700 DOI: 10.1007/s00330-023-09554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/04/2023] [Accepted: 02/22/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES We aimed to develop and evaluate a modified Liver Imaging Reporting and Data System (LI-RADS) version 2018 using significant ancillary features for diagnosing hepatocellular carcinoma (HCC) < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging (MRI). METHODS Patients who underwent preoperative gadoxetate disodium-enhanced MRI for focal solid nodules < 2.0 cm within 1 month of MRI between January 2016 and December 2020 were retrospectively analyzed. Major and ancillary features were compared between HCCs of < 1.0 cm and 1.0-1.9 cm using the chi-square test. Significant ancillary features associated with HCC < 1.0 cm were determined by univariable and multivariable logistic regression analysis. The sensitivity and specificity of LR-5 were compared between LI-RADS v2018 and our modified LI-RADS (applying the significant ancillary feature) using generalized estimating equations. RESULTS Of 796 included nodules, 248 were < 1.0 cm and 548 were 1.0-1.9 cm. HCC < 1.0 cm less frequently showed an enhancing capsule (7.1% vs. 31.1%, p < .001) and threshold growth (0% vs. 8.3%, p = .007) than HCC of 1.0-1.9 cm. Restricted diffusion was the only ancillary feature significant for diagnosing HCC < 1.0 cm (adjusted odds ratio = 11.50, p < .001). In the diagnosis of HCC, our modified LI-RADS using restricted diffusion had significantly higher sensitivity than LI-RADS v2018 (61.8% vs. 53.5%, p < .001), with similar specificity (97.3% vs. 97.8%, p = .157). CONCLUSION Restricted diffusion was the only significant independent ancillary feature for diagnosing HCC < 1.0 cm. Our modified LI-RADS using restricted diffusion can improve the sensitivity for HCC < 1.0 cm. KEY POINTS • The imaging features of hepatocellular carcinoma (HCC) < 1.0 cm differed from those of HCC of 1.0-1.9 cm. • Restricted diffusion was the only significant independent ancillary feature for HCC < 1.0 cm. • Modified Liver Imaging Reporting and Data System (LI-RADS) with the addition of restricted diffusion can improve the sensitivity for HCC < 1.0 cm.
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Affiliation(s)
- Hyeon Ji Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Se Jin Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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Qing Z, Yuan H, Hao X, Jie P. Diagnostic Value of CT Delayed Phase Images Added to Gd-EOB-DTPA MRI for HCC Diagnosis in LR-3/4 Lesions. Int J Gen Med 2023; 16:2383-2391. [PMID: 37333878 PMCID: PMC10275374 DOI: 10.2147/ijgm.s410123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Objective To explore the potential value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI) in the diagnosis of hepatocellular carcinoma (HCC) in LR-3/4 lesions by adding computed tomography (CT) delayed images based on the Liver Imaging Reporting And Data System (LI-RADS). Methods The differences in clinical and imaging characteristics between hepatocellular carcinoma and non-HCC were compared, and logistic regression was used to analyze the imaging risk factors for the diagnosis of HCC. Based on the main and HCC-specific auxiliary features of Gd-EOB-DTPA MRI, the HCC diagnostic model 1 was established, and the diagnostic efficacy was analyzed. Based on model 1, delayed phase CT images were added to establish model 2 to find reliable predictors of HCC diagnosis. Receiver operating characteristic (ROC) analysis and the DeLong test were used to compare the two models. Results There was a significant difference in serum AFP between HCC and non-HCC (P = 0.008). Based on main and HCC-specific auxiliary features of Gd-EOB-DTPA MRI, enhancing capsule (OR = 0.197, 95% CI = 0.06-0.595, P = 0.005) and washout (OR = 10.345, 95% CI = 3.460-30.930, P < 0.001) were independent risk factors in Model 1. After adding CT delayed-phase images to build model 2, enhancing capsule (OR = 0.132, 95% CI = 0.139-0.449, P = 0.001), MRI and (or) CT washout (OR = 0.052, 95% CI = 0.016-0.172, P < 0.001) were reliable predictors for HCC diagnosis. The AUC of model 1 was 0.808, sensitivity was 63.46%, and specificity was 85.00%. The AUC of model 2 was 0.854, the sensitivity was 71.20%, and the specificity was 85.00%. DeLong test (P = 0.040) demonstrated the diagnostic efficacy of model 2 significantly superior than model 1. Conclusion Tumor washout and enhanced capsule are reliable factors for the diagnosis of HCC. Gd-EOB-DTPA MRI with delayed phase CT images can improve the sensitivity and diagnostic efficiency of HCC in LR-3/4 lesions on the premise of maintaining high specificity. Future studies are required to reinforce our finding.
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Affiliation(s)
- Zhang Qing
- Department of Radiology, Jingzhou No 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou City, Hubei Province, 434000, People’s Republic of China
| | - Huang Yuan
- Department of Radiology, Jingzhou No 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou City, Hubei Province, 434000, People’s Republic of China
| | - Xiong Hao
- Department of Radiology, Jingzhou No 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou City, Hubei Province, 434000, People’s Republic of China
| | - Peng Jie
- Department of Radiology, Jingzhou No 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou City, Hubei Province, 434000, People’s Republic of China
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Park S, Byun J, Hwang SM. Utilization of a Machine Learning Algorithm for the Application of Ancillary Features to LI-RADS Categories LR3 and LR4 on Gadoxetate Disodium-Enhanced MRI. Cancers (Basel) 2023; 15:cancers15051361. [PMID: 36900153 PMCID: PMC10000173 DOI: 10.3390/cancers15051361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND This study aimed to identify the important ancillary features (AFs) and determine the utilization of a machine-learning-based strategy for applying AFs for LI-RADS LR3/4 observations on gadoxetate disodium-enhanced MRI. METHODS We retrospectively analyzed MRI features of LR3/4 determined with only major features. Uni- and multivariate analyses and random forest analysis were performed to identify AFs associated with HCC. A decision tree algorithm of applying AFs for LR3/4 was compared with other alternative strategies using McNemar's test. RESULTS We evaluated 246 observations from 165 patients. In multivariate analysis, restricted diffusion and mild-moderate T2 hyperintensity showed independent associations with HCC (odds ratios: 12.4 [p < 0.001] and 2.5 [p = 0.02]). In random forest analysis, restricted diffusion is the most important feature for HCC. Our decision tree algorithm showed higher AUC, sensitivity, and accuracy (0.84, 92.0%, and 84.5%) than the criteria of usage of restricted diffusion (0.78, 64.5%, and 76.4%; all p < 0.05); however, our decision tree algorithm showed lower specificity than the criterion of usage of restricted diffusion (71.1% vs. 91.3%; p < 0.001). CONCLUSION Our decision tree algorithm of applying AFs for LR3/4 shows significantly increased AUC, sensitivity, and accuracy but reduced specificity. These appear to be more appropriate in certain circumstances in which there is an emphasis on the early detection of HCC.
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Affiliation(s)
- Seongkeun Park
- Machine Intelligence Laboratory, Department of Smart Automobile, Soonchunhyang University, Asan 31538, Republic of Korea
| | - Jieun Byun
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
- Correspondence:
| | - Sook Min Hwang
- Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
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Song Y, Zhang YY, Yu Q, Chen T, Wei CG, Zhang R, Hu W, Qian XJ, Zhu Z, Zhang XW, Shen JK. A nomogram based on LI-RADS features, clinical indicators and quantitative contrast-enhanced MRI parameters for predicting glypican-3 expression in hepatocellular carcinoma. Front Oncol 2023; 13:1123141. [PMID: 36824129 PMCID: PMC9941525 DOI: 10.3389/fonc.2023.1123141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose Noninvasively assessing the tumor biology and microenvironment before treatment is greatly important, and glypican-3 (GPC-3) is a new-generation immunotherapy target for hepatocellular carcinoma (HCC). This study investigated the application value of a nomogram based on LI-RADS features, quantitative contrast-enhanced MRI parameters and clinical indicators in the noninvasive preoperative prediction of GPC-3 expression in HCC. Methods and materials We retrospectively reviewed 127 patients with pathologically confirmed solitary HCC who underwent Gd-EOB-DTPA MRI examinations and related laboratory tests. Quantitative contrast-enhanced MRI parameters and clinical indicators were collected by an abdominal radiologist, and LI-RADS features were independently assessed and recorded by three trained intermediate- and senior-level radiologists. The pathological and immunohistochemical results of HCC were determined by two senior pathologists. All patients were divided into a training cohort (88 cases) and validation cohort (39 cases). Univariate analysis and multivariate logistic regression were performed to identify independent predictors of GPC-3 expression in HCC, and a nomogram model was established in the training cohort. The performance of the nomogram was assessed by the area under the receiver operating characteristic curve (AUC) and the calibration curve in the training cohort and validation cohort, respectively. Results Blood products in mass, nodule-in-nodule architecture, mosaic architecture, contrast enhancement ratio (CER), transition phase lesion-liver parenchyma signal ratio (TP-LNR), and serum ferritin (Fer) were independent predictors of GPC-3 expression, with odds ratios (ORs) of 5.437, 10.682, 5.477, 11.788, 0.028, and 1.005, respectively. Nomogram based on LI-RADS features (blood products in mass, nodule-in-nodule architecture and mosaic architecture), quantitative contrast-enhanced MRI parameters (CER and TP-LNR) and clinical indicators (Fer) for predicting GPC-3 expression in HCC was established successfully. The nomogram showed good discrimination (AUC of 0.925 in the training cohort and 0.908 in the validation cohort) and favorable calibration. The diagnostic sensitivity and specificity were 76.9% and 92.3% in the training cohort, 76.8% and 93.8% in the validation cohort respectively. Conclusion The nomogram constructed from LI-RADS features, quantitative contrast-enhanced MRI parameters and clinical indicators has high application value, can accurately predict GPC-3 expression in HCC and may help noninvasively identify potential patients for GPC-3 immunotherapy.
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Affiliation(s)
- Yan Song
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China,Department of Radiology, Jieshou City People’s Hospital, Fuyang, China
| | - Yue-yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qin Yu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China,Department of Radiology, Dongtai City People’s Hospital, Yancheng, China
| | - Tong Chen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chao-gang Wei
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Hu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu-jun Qian
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhi Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xue-wu Zhang
- Department of Infectious Diseases, Jieshou City People’s Hospital, Fuyang, China
| | - Jun-kang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China,Institute of Imaging Medicine, Soochow University, Suzhou, China,*Correspondence: Jun-kang Shen,
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Kim YY, Choi JY. [CT/MRI Liver Imaging Reporting and Data System (LI-RADS): Standardization, Evidence, and Future Direction]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:15-33. [PMID: 36818714 PMCID: PMC9935963 DOI: 10.3348/jksr.2022.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/29/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
The liver imaging reporting and data system (LI-RADS) has been developed with the support of the American College of Radiology to standardize the diagnosis and evaluation of treatment response of hepatocellular carcinoma (HCC). The CT/MRI LI-RADS version 2018 has been incorporated in the American Association for the Study of Liver Diseases guidance. This review examines the effect of CT/MRI LI-RADS on the standardized reporting of liver imaging, and the evidence in diagnosing HCC and evaluating treatment response after locoregional treatment using CT/MRI LI-RADS. The results are compared with other HCC diagnosis guidelines, and future directions are described.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Xie S, Zhang Y, Chen J, Jiang T, Liu W, Rong D, Sun L, Zhang L, He B, Wang J. Can modified LI-RADS increase the sensitivity of LI-RADS v2018 for the diagnosis of 10-19 mm hepatocellular carcinoma on gadoxetic acid-enhanced MRI? Abdom Radiol (NY) 2022; 47:596-607. [PMID: 34773467 DOI: 10.1007/s00261-021-03339-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate whether the Liver Imaging Reporting and Data System (LI-RADS) v2018 LR-5 criteria can be modified to increase sensitivity without reducing specificity for diagnosing 10-19 mm hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI). METHODS A total of 133 high-risk consecutive patients with 174 small observations (10-19 mm) detected on gadoxetic acid-enhanced MRI were retrospectively studied. LI-RADS MRI major features (MFs) and ancillary features (AFs) were reviewed by two independent radiologists in consensus. Observations were categorized using LI-RADS v2018 MFs. Independently significant AFs were identified through logistic regression analysis. Upgraded LR-5 criteria were developed by combining independently significant AFs with MFs of LR-3 or LR-4 v2018. The sensitivity and specificity of the new diagnostic criteria were compared with those of LR-5 v2018 using McNemar's test. RESULTS Three of the AFs favoring malignancy [mild-moderate T2 hyperintensity, transitional phase (TP) hypointensity and fat in mass] were independently significant features for diagnosing 10-19 mm HCC. The upgraded LR-5 criteria (mLI-RADS VII: LR-4 + mild-moderate T2 hyperintensity/TP hypointensity or LR-3 + fat in mass) yielded a significantly greater sensitivity than that of the LR-5 v2018 criteria (70.4% vs 55.1%; p < 0.001), whereas the specificity was not significantly different (94.7% vs 98.7%, p = 0.250). CONCLUSIONS Independently significant AFs may be used to upgrade an observation from LR-3/LR-4 to LR-5, which can improve the sensitivity without impairing the specificity for diagnosing 10-19 mm HCC on gadoxetic acid-enhanced MRI.
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Affiliation(s)
- Sidong Xie
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Yao Zhang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Jingbiao Chen
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Ting Jiang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Weimin Liu
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Dailin Rong
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Lin Sun
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Linqi Zhang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Bingjun He
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, 510630, Guangdong, People's Republic of China.
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Jiang H, Song B, Qin Y, Wei Y, Konanur M, Wu Y, Zaki IH, McInnes MDF, Lafata KJ, Bashir MR. Data-Driven Modification of the LI-RADS Major Feature System on Gadoxetate Disodium-Enhanced MRI: Toward Better Sensitivity and Simplicity. J Magn Reson Imaging 2022; 55:493-506. [PMID: 34236120 DOI: 10.1002/jmri.27824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Liver Imaging Reporting and Data System (LI-RADS) is widely accepted as a reliable diagnostic scheme for hepatocellular carcinoma (HCC) in at-risk patients. However, its application is hampered by substantial complexity and suboptimal diagnostic sensitivity. PURPOSE To propose data-driven modifications to the LI-RADS version 2018 (v2018) major feature system (rLI-RADS) on gadoxetate disodium (EOB)-enhanced magnetic resonance imaging (MRI) to improve sensitivity and simplicity while maintaining high positive predictive value (PPV) for detecting HCC. STUDY TYPE Retrospective. POPULATION Two hundred and twenty-four consecutive at-risk patients (training dataset: 169, independent testing dataset: 55) with 742 LR-3 to LR-5 liver observations (HCC: N = 498 [67%]) were analyzed from a prospective observational registry collected between July 2015 and September 2018. FIELD STRENGTH/SEQUENCE 3.0 T/T2-weighted fast spin-echo, diffusion-weighted spin-echo based echo-planar and three-dimensional (3D) T1-weighted gradient echo sequences. ASSESSMENT All images were evaluated by three independent abdominal radiologists who were blinded to all clinical, pathological, and follow-up information. Composite reference standards of either histopathology or imaging follow-up were used. STATISTICAL TESTS In the training dataset, LI-RADS v2018 major features were used to develop rLI-RADS based on their associated PPV for HCC. In an independent testing set, diagnostic performances of LI-RADS v2018 and rLI-RADS were computed using a generalized estimating equation model and compared with McNemar's test. A P value <0.05 was considered statistically significant. RESULTS The median (interquartile range) size of liver observations was 13 mm (7-27 mm). The diagnostic table for rLI-RADS encompassed 9 cells, as opposed to 16 cells for LI-RADS v2018. In the testing set, compared to LI-RADS v2018, rLI-RADS category 5 demonstrated a significantly superior sensitivity (76% vs. 61%) while maintaining comparably high PPV (92.5% vs. 94.1%, P = 0.126). DATA CONCLUSION Compared with LI-RADS v2018, rLI-RADS demonstrated improved simplicity and significantly superior diagnostic sensitivity for HCC in at-risk patients. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Meghana Konanur
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuanan Wu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Islam H Zaki
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Matthew D F McInnes
- Departments of Radiology and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kyle J Lafata
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
- Center for Advanced Magnetic Resonance in Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Kim YY, Min JH, Hwang JA, Jeong WK, Sinn DH, Lim HK. Second-line Sonazoid-enhanced ultrasonography for Liver Imaging Reporting and Data System category 3 and 4 on gadoxetate-enhanced magnetic resonance imaging. Ultrasonography 2022; 41:519-529. [PMID: 35439873 PMCID: PMC9262668 DOI: 10.14366/usg.21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/28/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study investigated the utility of second-line contrast-enhanced ultrasonography (CEUS) using Sonazoid in Liver Imaging Reporting and Data System category 3 (LR-3) and 4 (LR-4) observations on gadoxetate-enhanced magnetic resonance imaging (MRI). Methods This retrospective study included LR-3 or LR-4 observations on gadoxetate-enhanced MRI subsequently evaluated with CEUS from 2013 to 2017. The presence of MRI features, CEUS-arterial phase hyperenhancement (CEUS-APHE), and Kupffer phase defect (KPD) was evaluated. Multivariable logistic regression analysis was performed to identify significant imaging features associated with the diagnosis of hepatocellular carcinoma (HCC). The optimal diagnostic criteria were investigated using the McNemar test. Results In total, 104 patients with 104 observations (63 HCCs) were included. The presence of both CEUS-APHE and KPD on CEUS enabled the additional detection of 42.3% (11/26) of LR-3 HCCs and 78.4% (29/37) of LR-4 HCCs. Transitional phase (TP) hypointensity (adjusted odds ratio [OR], 10.59; P<0.001), restricted diffusion (adjusted OR, 7.55; P=0.004), and KPD (adjusted OR, 7.16; P=0.003) were significant imaging features for HCC diagnosis. The presence of at least two significant imaging features was optimal for HCC diagnosis (sensitivity, specificity, and accuracy: 88.9%, 78.1%, and 84.6%, respectively), with significantly higher sensitivity than the presence of both CEUS-APHE and KPD (sensitivity, specificity, and accuracy: 63.5% [P=0.001], 92.7% [P=0.077], and 75.0% [P=0.089], respectively). Conclusion The combined interpretation of gadoxetate-enhanced MRI and second-line CEUS using Sonazoid, focusing on TP hypointensity, restricted diffusion, and KPD, may be optimal for further characterizing LR-3 and LR-4 observations.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cannella R, Vernuccio F, Antonucci M, Gagliano DS, Matteini F, Midiri M, Brancatelli G. LI-RADS ancillary features favoring benignity: is there a role in LR-5 observations? Eur Radiol 2021; 32:1804-1812. [PMID: 34545444 DOI: 10.1007/s00330-021-08267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Liver Imaging Reporting and Data System algorithm allows category downgrade in the presence of ancillary features (AFs) favoring benignity, even in observations categorized as LR-5. This study aims to assess the role of AFs favoring benignity in LR-5 observations and their impact on category downgrade. METHODS This study included high-risk patients with at least one LR-5 observation imaged with gadoxetate disodium MRI. Three readers with different experience levels independently evaluated the presence of AFs favoring malignancy (not hepatocellular carcinoma (HCC) in particular and HCC in particular) and AFs favoring benignity. Category downgrade was considered possible in the presence of ≥ 1 AF favoring benignity and no AF favoring malignancy. Correlation between observations size and number of AFs was assessed using Spearman's rank correlation coefficient. Cohen's kappa (k) test was used to assess inter-reader agreement. RESULTS The final study cohort included 162 LR-5 (mean size: 23 ± 16 mm) in 119 patients. AFs favoring benignity were reported in 9 (5.6%), 20 (12.3%), and 10 (6.2%) LR-5 observations by reader 1, reader 2, and reader 3, respectively. Hepatobiliary phase isointensity was observed in 6 (3.7%), 2 (1.2%), and 7 (4.3%) observations, respectively. Category downgrade was considered possible in only one (0.6%) observation by reader 1 and reader 3. There was a significant correlation between observation size and number of AFs favoring malignancy (p < 0.001), not HCC in particular (p ≤ 0.010), and favoring HCC in particular (p < 0.001). Inter-reader agreement of AFs favoring benignity was poor to moderate (k range: - 0.01, 0.43). CONCLUSIONS AFs favoring benignity are not uncommon in LR-5 observations, but category downgrade is exceptional. KEY POINTS • Ancillary features favoring benignity are encountered in 5.6-12.3% of observations categorized as LR-5. • Category downgrade of LR-5 observations is very rare (0.6% of observations) in the presence of AFs favoring benignity due to the high prevalence (98-99%) of ancillary features favoring malignancy in LR-5 observations. • The inter-reader agreement of ancillary features favoring benignity is poor to moderate (k range: - 0.01, 0.43) in readers with different levels of experience.
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Affiliation(s)
- Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy.
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127, Palermo, Italy.
| | - Federica Vernuccio
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Michela Antonucci
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Domenico Salvatore Gagliano
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Francesco Matteini
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Massimo Midiri
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics, BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
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Kim DH, Choi SH, Shim JH, Kim SY, Lee SS, Byun JH, Choi JI. Meta-Analysis of the Accuracy of Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: Non-Contrast versus Hepatobiliary Phase-Abbreviated Magnetic Resonance Imaging. Cancers (Basel) 2021; 13:cancers13122975. [PMID: 34198589 PMCID: PMC8231787 DOI: 10.3390/cancers13122975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Ultrasonography is recommended as a standard surveillance modality, but the performance of surveillance ultrasound for detecting early-stage hepatocellular carcinoma (HCC) is limited. Motivated to provide a more sensitive method, abbreviated magnetic resonance imaging (AMRI) protocols have been introduced for HCC surveillance. We aimed to systematically determine the diagnostic performance of surveillance AMRI for detecting HCC. This meta-analysis of 10 studies comprising 1547 patients found that the pooled sensitivity and specificity of surveillance AMRI for detecting HCC were 86% and 96%, respectively. Hepatobiliary phase contrast-enhanced AMRI showed significantly higher sensitivities for detecting HCC than non-contrast AMRI (87% vs. 82%), but significantly lower specificities (93% vs. 98%). Therefore, surveillance AMRI had overall good diagnostic performance for detecting HCC and might be clinically useful for HCC surveillance. In addition, AMRI protocol should be selected with consideration of the advantages and disadvantages of each protocol. Abstract We aimed to determine the performance of surveillance abbreviated magnetic resonance imaging (AMRI) for detecting hepatocellular carcinoma (HCC), and to compare the performance of surveillance AMRI according to different protocols. Original research studies reporting the performance of surveillance AMRI for the detection of HCC were identified in MEDLINE, EMBASE, and Cochrane databases. The pooled sensitivity and specificity of surveillance AMRI were calculated using a hierarchical model. The pooled sensitivity and specificity of contrast-enhanced hepatobiliary phase (HBP)-AMRI and non-contrast (NC)-AMRI were calculated and compared using bivariate meta-regression. Ten studies, including 1547 patients, reported the accuracy of surveillance AMRI. The pooled sensitivity and specificity of surveillance AMRI for detecting any-stage HCC were 86% (95% confidence interval (CI), 80–90%; I2 = 0%) and 96% (95% CI, 93–98%; I2 = 80.5%), respectively. HBP-AMRI showed a significantly higher sensitivity for detecting HCC than NC-AMRI (87% vs. 82%), but significantly lower specificity (93% vs. 98%) (p = 0.03). Study quality and MRI magnet field strength were factors significantly associated with study heterogeneity (p ≤ 0.01). In conclusion, surveillance AMRI showed good overall diagnostic performance for detecting HCC. HBP-AMRI had significantly higher sensitivity for detecting HCC than NC-AMRI, but lower specificity.
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Affiliation(s)
- Dong Hwan Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.H.K.); (J.-I.C.)
| | - Sang Hyun Choi
- Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (S.S.L.); (J.H.B.)
- Correspondence: ; Tel.: +8-223-010-1797; Fax: +8-22-476-4719
| | - Ju Hyun Shim
- Asan Medical Center, Department of Gastroenterology, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - So Yeon Kim
- Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (S.S.L.); (J.H.B.)
| | - Seung Soo Lee
- Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (S.S.L.); (J.H.B.)
| | - Jae Ho Byun
- Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (S.S.L.); (J.H.B.)
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.H.K.); (J.-I.C.)
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Li L, Hu Y, Han J, Li Q, Peng C, Zhou J. Clinical Application of Liver Imaging Reporting and Data System for Characterizing Liver Neoplasms: A Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11020323. [PMID: 33671158 PMCID: PMC7921912 DOI: 10.3390/diagnostics11020323] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 02/07/2023] Open
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging in patients at risk of developing hepatocellular carcinoma (HCC). We aimed to determine the diagnostic performance of LI-RADS category 5 (LR5) for diagnosing HCC and LI-RADS category M (LRM) for characterizing other non-HCC malignancies (OM) using contrast-enhanced ultrasound (CEUS) and computed tomography (CT)/magnetic resonance imaging (MRI). Multiple databases were searched for articles evaluating the diagnostic accuracy of CEUS LI-RADS and/or CT/MRI LI-RADS. A random-effects model was adopted to synthesize the summary estimates of the diagnostic accuracy of LR5 for diagnosing HCC and LRM for characterizing OM using CEUS and CT/MRI. The pooled sensitivity and specificity of CEUS LR5 for the diagnosis of HCC were 69% and 93%, respectively. The pooled sensitivity was 67% and the specificity, 93% of CT/MRI LR5 for HCC diagnosis. There was no significant difference between the overall diagnostic accuracy for HCC diagnosis of CEUS LR5 and that of CT/MRI LR5 in terms of diagnostic odds ratio (DOR) (p = 0.55). The sensitivity was 84% with a specificity of 90% in the CEUS LRM for characterizing OM, while the sensitivity and specificity of CT/MRI LRM for characterizing OM was 63% and 95%. The DOR of CEUS LRM for characterizing OM was higher than that of CT/MRI LRM without significant difference (50.59 vs. 36.06, p = 0.34). This meta-analysis indicated that CEUS LI-RADS is qualified to characterize HCC and OM and may provide complementary information on liver nodules to CT/MRI LI-RADS.
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Affiliation(s)
| | | | | | | | | | - Jianhua Zhou
- Correspondence: ; Tel.: +86-13711757623; Fax: +86-87343211
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15
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Darnell A, Rimola J, Belmonte E, Ripoll E, Garcia-Criado Á, Caparroz C, Díaz-González Á, Vilana R, Reig M, Ayuso C, Bruix J, Forner A. Evaluation of LI-RADS 3 category by magnetic resonance in US-detected nodules ≤ 2 cm in cirrhotic patients. Eur Radiol 2021; 31:4794-4803. [PMID: 33409789 DOI: 10.1007/s00330-020-07457-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/15/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) diagnosis in high-risk patients is a dynamic system, which was lastly updated in 2018. We aimed to evaluate the accuracy for HCC diagnosis of LI-RADS v2018 with magnetic resonance imaging (MRI) with extracellular contrast for solitary nodules ≤ 20 mm detected during ultrasound (US) surveillance in cirrhotic patients, with particular interest in those observations categorized as LI-RADS 3. METHODS Between November 2003 and February 2017, we included 262 consecutive cirrhotic patients with a newly US-detected solitary ≤ 20-mm nodule. A LI-RADS (LR) v2018 category was retrospectively assigned. The diagnostic accuracy for each LR category was described, and the main MRI findings associated with HCC diagnosis were analyzed. RESULTS Final diagnoses were as follows: 197 HCC (75.2%), 5 cholangiocarcinoma (1.9%), 2 metastasis (0.8%), and 58 benign lesions (22.1%); 0/15 (0%) LR-1, 6/26 (23.1%) LR-2, 51/74 (68.9%) LR-3, 11/12 (91.7%) LR-4, 126/127 (99.2%) LR-5, and 3/8 (37.5%) LR-M were HCC. LR-5 category displayed a sensitivity and specificity of 64% (95% CI, 56.8-70.7) and 98.5% (95% CI, 91.7-100), respectively. Considering also LR-4 as diagnostic for HCC, the sensitivity slightly increased to 69.5% (95% CI, 62.6-75.9) with minor impact on specificity (96.2%; 95% CI, 89.3-99.6). Regarding LR-3 observations, 51 out of 74 were HCC, 2 were non-HCC malignancies, and 20 out of 21 LR-3 nodules > 15 mm (95.2%) were finally categorized as HCC. CONCLUSIONS The high probability of HCC in US-detected LR-3 observations (68.9%) justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage. KEY POINTS • In cirrhotic patients with nodules ≤ 20 mm detected during US surveillance, 51 out of 74 (68.9%) of LR-3 nodules by MRI corresponded to an HCC. • In LR-3 nodules, HCC diagnosis was closely related to baseline tumor size. All 5 nodules smaller than 1 cm were diagnosed as benign. Oppositely, 20 out of 21 LR-3 observations > 15 mm (95.2%) were diagnosed as HCC. • The high probability of HCC in US-detected LR-3 observations justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage.
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Affiliation(s)
- Anna Darnell
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ernest Belmonte
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Enric Ripoll
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ángeles Garcia-Criado
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carla Caparroz
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Álvaro Díaz-González
- BCLC Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170, Escala 11, 4a planta, 08036, Barcelona, Spain
| | - Ramón Vilana
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- BCLC Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170, Escala 11, 4a planta, 08036, Barcelona, Spain
| | - María Reig
- BCLC Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170, Escala 11, 4a planta, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Carmen Ayuso
- BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Jordi Bruix
- BCLC Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170, Escala 11, 4a planta, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Alejandro Forner
- BCLC Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170, Escala 11, 4a planta, 08036, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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LI-RADS-Nebenkriterien: Sehr unterschiedliche Bedeutung für die HCC-Diagnostik. ROFO-FORTSCHR RONTG 2020. [DOI: 10.1055/a-1192-9648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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