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Lee S, Kim YY, Shin J, Shin H, Sirlin CB, Chernyak V. Performance of LI-RADS category 5 vs combined categories 4 and 5: a systemic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10813-5. [PMID: 38809263 DOI: 10.1007/s00330-024-10813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS, LR) category 5 has high specificity and modest sensitivity for diagnosis of hepatocellular carcinoma (HCC). The purpose of this study was to compare the diagnostic performance of LR-5 vs combined LR-4 and LR-5 (LR-4/5) for HCC diagnosis. METHODS MEDLINE and EMBASE databases through January 03, 2023 were searched for studies reporting the performance of LR-5 and combined LR-4/5 for HCC diagnosis, using CT/MRI LI-RADS version 2014, 2017, or 2018. A bivariate random-effects model was used to calculate the pooled per-observation diagnostic performance. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Sixty-nine studies (15,108 observations, 9928 (65.7%) HCCs) were included. Compared to LR-5, combined LR-4/5 showed significantly higher pooled sensitivity (83.0% (95% CI [80.3-85.8%]) vs 65.7% (95% CI [62.4-69.1%]); p < 0.001), lower pooled specificity (75.0% (95% CI [70.5-79.6%]) vs 91.7% (95% CI [90.2-93.1%]); p < 0.001), lower pooled positive likelihood ratio (3.60 (95% CI [3.06-4.23]) vs 6.18 (95% CI [5.35-7.14]); p < 0.001), and lower pooled negative likelihood ratio (0.22 (95% CI [0.19-0.25]) vs 0.38 (95% CI [0.35-0.41]) vs; p < 0.001). Similar results were seen in all subgroups. CONCLUSIONS Our meta-analysis showed that combining LR-4 and LR-5 would increase sensitivity but decrease specificity, positive likelihood ratio, and negative likelihood ratio. These findings may inform management guidelines and individualized management. CLINICAL RELEVANCE STATEMENT This meta-analysis estimated the magnitude of changes in the sensitivity and specificity of imaging criteria when LI-RADS categories 4 and 5 were combined; these findings can inform management guidelines and individualized management. KEY POINTS There is no single worldwide reporting system for liver imaging, partly due to regional needs. Combining LI-RADS categories 4 and 5 increased sensitivity and decreased specificity and positive and negative likelihood ratios. Changes in the sensitivity and specificity of imaging criteria can inform management guidelines and individualized management.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyejung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Huang R, Zheng C, Xu G, Chen X, Shen J, Mao S. A Modified Targetoid Feature Emphasizing Thin-Rim APHE to Improve the Diagnostic Performance of LI-RADS for Malignant Hepatic Tumors. J Hepatocell Carcinoma 2024; 11:775-786. [PMID: 38689802 PMCID: PMC11060173 DOI: 10.2147/jhc.s448257] [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: 11/21/2023] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
Objective To identify imaging features that help distinguish between HCCs and non-HCC malignancies assigned to LI-RADS M (LR-M) and evaluate the diagnostic performance of a LI-RADS with targetoid criteria using thin-rim arterial phase hyperenhancement (APHE). Materials and Methods This retrospective study included 381 patients (387 observations) at high-risk for HCC who underwent enhanced-MRI before surgery. Three radiologists reviewed images for LI-RADS categorization of hepatic observations. Univariate and multivariate analysis was conducted to determine reliable features to differentiate between HCC and non-HCC malignancies among the LR-M lesions. The thin-rim (<30%) APHE was defined based on the thickest thickness of rim APHE compared with the tumor radius, and a modified LI-RADS emphasizing thin-rim APHE as a specific feature of LR-M was established. We compared the diagnostic performance of modified LR-M and LI-RADS 5 (LR-5) with the conventional one. Results Thin-rim APHE and targetoid diffusion-weighted imaging (DWI) were found as independent predictive factors of non-HCC malignancies, while enhancing capsule, thick-rim APHE and peripheral washout were noted as independent variables significantly associated with HCC of LR-M (P<0.05). The noticeable diagnostic performance of thin-rim APHE in distinguishing non-HCC malignancies from HCCs using the ROC curve. Emphasizing thin-rim APHE on targetoid features, the modified LR-M revealed significantly superior specificity and accuracy (89.4% vs 81.1%, P=0.004; and 87.9% vs 82.2%, P=0.027, respectively) while maintaining high sensitivity (82.2% vs 86.0%; P=0.529) compared with the LR-M. Meanwhile, the modified LR-5 achieved greater sensitivity and accuracy (88.6% vs 79.7%, P=0.004; and 85.8% vs 80.1%, P=0.036, respectively) for diagnosing HCC, without compromising specificity (78.3% vs.81.1%; P=0.608) compared with the LR-5. Conclusion Thin-rim APHE may be the specific imaging feature for differentiating non-HCC malignancies from HCCs within LR-M. The modified targetoid criteria emphasizing thin-rim APHE can improve the diagnostic performance of LI-RADS for hepatic malignancies.
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Affiliation(s)
- Runqian Huang
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Chunling Zheng
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Guixiao Xu
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Xuanwei Chen
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Jingxian Shen
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
| | - Siyue Mao
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China
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Lee S, Kim YY, Shin J, Roh YH, Choi JY, Chernyak V, Sirlin CB. Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis. Eur Radiol 2024; 34:1502-1514. [PMID: 37656177 DOI: 10.1007/s00330-023-10134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/24/2023] [Accepted: 07/07/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We performed an updated meta-analysis to determine the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS, LR) 5 category for hepatocellular carcinoma (HCC) using LI-RADS version 2018 (v2018), and to evaluate differences by imaging modalities and type of MRI contrast material. METHODS The MEDLINE and Embase databases were searched for studies reporting the performance of LR-5 using v2018 for diagnosing HCC. A bivariate random-effects model was used to calculate the pooled per-observation sensitivity and specificity. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Forty-eight studies qualified for the meta-analysis, comprising 9031 patients, 10,547 observations, and 7216 HCCs. The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC were 66% (95% CI, 61-70%) and 91% (95% CI, 89-93%), respectively. In the subgroup analysis, MRI with extracellular agent (ECA-MRI) showed significantly higher pooled sensitivity (77% [95% CI, 70-82%]) than CT (66% [95% CI, 58-73%]; p = 0.023) or MRI with gadoxetate (Gx-MRI) (65% [95% CI, 60-70%]; p = 0.001), but there was no significant difference between ECA-MRI and MRI with gadobenate (gadobenate-MRI) (73% [95% CI, 61-82%]; p = 0.495). Pooled specificities were 88% (95% CI, 80-93%) for CT, 92% (95% CI, 86-95%) for ECA-MRI, 93% (95% CI, 91-95%) for Gx-MRI, and 91% (95% CI, 84-95%) for gadobenate-MRI without significant differences (p = 0.084-0.803). CONCLUSIONS LI-RADS v2018 LR-5 provides high specificity for HCC diagnosis regardless of modality or contrast material, while ECA-MRI showed higher sensitivity than CT or Gx-MRI. CLINICAL RELEVANCE STATEMENT Refinement of the criteria for improving sensitivity while maintaining high specificity of LR-5 for HCC diagnosis may be an essential future direction. KEY POINTS • The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC using LI-RADSv2018 were 66% and 91%, respectively. • ECA-MRI showed higher sensitivity than CT (77% vs 66%, p = 0.023) or Gx-MRI (77% vs 65%, p = 0.001). • LI-RADS v2018 LR-5 provides high specificity (88-93%) for HCC diagnosis regardless of modality or contrast material type.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
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Chen J, Chen H, Zheng D, Yan C, Ye R, Wen L, Li Y. LI-RADS category 3, 4, and M observations: a multiple parameters diagnostic model for hepatocellular carcinoma. Acta Radiol 2023; 64:2977-2986. [PMID: 37753552 DOI: 10.1177/02841851231203830] [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: 09/28/2023]
Abstract
BACKGROUND Hepatic lesions categorized as LR-3, LR-4, and LR-M are challenging to accurately assess and diagnose. PURPOSE To combine potential clinical and/or magnetic resonance imaging (MRI) features for a more comprehensive hepatocellular carcinoma (HCC) versus non-HCC diagnosis for patients with LR-3, LR-4, and LR-M graded lesions. METHODS Data were consecutively retrieved from 82 at-risk patients with LR-3 (n = 43), LR-4 (n = 20), and LR-M (n = 23) lesions. Significant findings for the differentiation of HCC and non-HCC, including MRI features and clinical factors, were identified with univariable and multivariable analyses. The variables for a prediction model were selected through stepwise use of Akaike's Information Criterion (AIC) to build multivariable logistic regression model. RESULTS Serum alpha-fetoprotein (AFP) >16.2 ng/mL (odds ratio [OR] = 22.4; P = 0.006), septum (OR = 52.1; P = 0.011), and hepatobiliary phase (HBP) hypointensity (OR = 40.2; P = 0.001) were confirmed as independent predictors of HCC. When combining the three predictors and mild-moderate T2 hyperintensity, the model (AIC = 50.91) showed good accuracy with a C-index of 0.948. CONCLUSION In at-risk patients with LR-3, LR-4, or LR-M lesions, integrating AFP, septum, HBP hypointensity, and mild-moderate T2 hyperintensity achieved high diagnostic performance for the diagnosis of HCC.
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Affiliation(s)
- Jianwei Chen
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, PR China
| | - Huizhen Chen
- Department of Good Clinical Practice, Fuzhou Pulmonary Hospital, Fuzhou, Fujian Province, PR China
| | - Dechun Zheng
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, PR China
| | - Chuan Yan
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, PR China
| | - Rongping Ye
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, PR China
| | - Liting Wen
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, PR China
| | - Yueming Li
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, PR China
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Mendes Serrão E, Klug M, Moloney BM, Jhaveri A, Lo Gullo R, Pinker K, Luker G, Haider MA, Shinagare AB, Liu X. Current Status of Cancer Genomics and Imaging Phenotypes: What Radiologists Need to Know. Radiol Imaging Cancer 2023; 5:e220153. [PMID: 37921555 DOI: 10.1148/rycan.220153] [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: 11/04/2023]
Abstract
Ongoing discoveries in cancer genomics and epigenomics have revolutionized clinical oncology and precision health care. This knowledge provides unprecedented insights into tumor biology and heterogeneity within a single tumor, among primary and metastatic lesions, and among patients with the same histologic type of cancer. Large-scale genomic sequencing studies also sparked the development of new tumor classifications, biomarkers, and targeted therapies. Because of the central role of imaging in cancer diagnosis and therapy, radiologists need to be familiar with the basic concepts of genomics, which are now becoming the new norm in oncologic clinical practice. By incorporating these concepts into clinical practice, radiologists can make their imaging interpretations more meaningful and specific, facilitate multidisciplinary clinical dialogue and interventions, and provide better patient-centric care. This review article highlights basic concepts of genomics and epigenomics, reviews the most common genetic alterations in cancer, and discusses the implications of these concepts on imaging by organ system in a case-based manner. This information will help stimulate new innovations in imaging research, accelerate the development and validation of new imaging biomarkers, and motivate efforts to bring new molecular and functional imaging methods to clinical radiology. Keywords: Oncology, Cancer Genomics, Epignomics, Radiogenomics, Imaging Markers Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Eva Mendes Serrão
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Maximiliano Klug
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Brian M Moloney
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Aaditeya Jhaveri
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Roberto Lo Gullo
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Katja Pinker
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Gary Luker
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Masoom A Haider
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Atul B Shinagare
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
| | - Xiaoyang Liu
- From the Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2 (E.M.S., A.J., M.A.H., X.L.); Division of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (M.K.); Department of Radiology, The Christie NHS Trust, Manchester, England (B.M.M.); Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY (R.L.G., K.P.); Center for Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Mich (G.L.); Lunenfeld Tanenbaum Research Institute, Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (M.A.H.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (A.B.S.)
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Park SH, Heo S, Kim B, Lee J, Choi HJ, Sung PS, Choi JI. Targetoid Primary Liver Malignancy in Chronic Liver Disease: Prediction of Postoperative Survival Using Preoperative MRI Findings and Clinical Factors. Korean J Radiol 2023; 24:190-203. [PMID: 36788766 PMCID: PMC9971837 DOI: 10.3348/kjr.2022.0560] [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: 02/24/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE We aimed to assess and validate the radiologic and clinical factors that were associated with recurrence and survival after curative surgery for heterogeneous targetoid primary liver malignancies in patients with chronic liver disease and to develop scoring systems for risk stratification. MATERIALS AND METHODS This multicenter retrospective study included 197 consecutive patients with chronic liver disease who had a single targetoid primary liver malignancy (142 hepatocellular carcinomas, 37 cholangiocarcinomas, 17 combined hepatocellular carcinoma-cholangiocarcinomas, and one neuroendocrine carcinoma) identified on preoperative gadoxetic acid-enhanced MRI and subsequently surgically removed between 2010 and 2017. Of these, 120 patients constituted the development cohort, and 77 patients from separate institution served as an external validation cohort. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were identified using a Cox proportional hazards analysis, and risk scores were developed. The discriminatory power of the risk scores in the external validation cohort was evaluated using the Harrell C-index. The Kaplan-Meier curves were used to estimate RFS and OS for the different risk-score groups. RESULTS In RFS model 1, which eliminated features exclusively accessible on the hepatobiliary phase (HBP), tumor size of 2-5 cm or > 5 cm, and thin-rim arterial phase hyperenhancement (APHE) were included. In RFS model 2, tumors with a size of > 5 cm, tumor in vein (TIV), and HBP hypointense nodules without APHE were included. The OS model included a tumor size of > 5 cm, thin-rim APHE, TIV, and tumor vascular involvement other than TIV. The risk scores of the models showed good discriminatory performance in the external validation set (C-index, 0.62-0.76). The scoring system categorized the patients into three risk groups: favorable, intermediate, and poor, each with a distinct survival outcome (all log-rank p < 0.05). CONCLUSION Risk scores based on rim arterial enhancement pattern, tumor size, HBP findings, and radiologic vascular invasion status may help predict postoperative RFS and OS in patients with targetoid primary liver malignancies.
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Affiliation(s)
- So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Subin Heo
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jungbok Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wang R, Xu H, Chen W, Jin L, Ma Z, Wen L, Wang H, Cao K, Du X, Li M. Gadoxetic acid-enhanced MRI with a focus on LI-RADS v2018 imaging features predicts the prognosis after radiofrequency ablation in small hepatocellular carcinoma. Front Oncol 2023; 13:975216. [PMID: 36816925 PMCID: PMC9932892 DOI: 10.3389/fonc.2023.975216] [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: 06/22/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Gadoxetic acid-enhanced magnetic resonance imaging (MRI) contributes to evaluating the prognosis of small hepatocellular carcinoma (sHCC) following treatment. We have investigated the potential role of gadoxetic acid-enhanced MRI based on LI-RADS (Liver Imaging Reporting and Data System) v2018 imaging features in the prognosis prediction of patients with sHCC treated with radiofrequency ablation (RFA) as the first-line treatment and formulated a predictive nomogram. Methods A total of 204 patients with sHCC who all received RFA as the first-line therapy were enrolled. All patients had undergone gadoxetic acid-enhanced MRI examinations before RFA. Uni- and multivariable analyses for RFS were assessing using a Cox proportional hazards model. A novel nomogram was further constructed for predicting RFS. The clinical capacity of the model was validated according to calibration curves, the concordance index (C-index), and decision curve analyses. Results Alpha fetoprotein (AFP) > 100 ng/ml (HR, 2.006; 95% CI, 1.111-3.621; P = 0.021), rim arterial phase hyperenhancement (APHE) (HR, 2.751; 95% CI, 1.511-5.011; P = 0.001), and targetoid restriction on diffusion-weighted imaging (DWI) (HR, 3.289; 95% CI, 1.832-5.906; P < 0.001) were considered as the independent risk features for recurrence in patients with sHCC treated with RFA. The calibration curves and C-indexes (C-index values of 0.758 and 0.807) showed the superior predictive performance of the integrated nomogram in both the training and validation groups. Discussion The gadoxetic acid-enhanced MRI features based on LI-RADS v2018, including rim APHE, targetoid restriction on DWI, and the AFP level, are the independent risk factors of recurrence in patients with sHCC treated with RFA as the first-line therapy. The predictive clinical-radiological nomogram model was constructed for clinicians to develop individualized treatment and surveillance strategies.
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Affiliation(s)
- Ruizhi Wang
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Hengtian Xu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wufei Chen
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Liang Jin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhuangxuan Ma
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Lei Wen
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hongwei Wang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Kun Cao
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xia Du
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China,*Correspondence: Xia Du, ; Ming Li,
| | - Ming Li
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China,*Correspondence: Xia Du, ; Ming Li,
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Lee S, Kim YY, Shin J, Son WJ, Roh YH, Choi JY, Sirlin CB, Chernyak V. Percentages of Hepatocellular Carcinoma in LI-RADS Categories with CT and MRI: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e220646. [PMID: 36625748 DOI: 10.1148/radiol.220646] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The Liver Imaging Reporting and Data System (LI-RADS) CT and MRI algorithm applies equally to CT, MRI with extracellular contrast agents (ECA-MRI), and MRI with gadoxetate (Gx-MRI). Purpose To estimate pooled percentages of hepatocellular carcinoma (HCC) and overall malignancy for each LI-RADS category with CT and MRI. Materials and Methods MEDLINE and EMBASE databases were searched for research articles (January 2014-April 2021) reporting the percentages of observations in each LI-RADS category with use of versions 2014, 2017, or 2018. Study design, population characteristics, imaging modality, reference standard, and numbers of HCC and non-HCC malignancies in each category were recorded. A random-effects model evaluated the pooled percentage of HCC and overall malignancy for each category. Results There were 49 studies with 9620 patients and a total 11 562 observations, comprising 7921 HCCs, 1132 non-HCC malignancies, and 2509 benign entities. No HCC or non-HCC malignancies were reported with any modality in the LR-1 category. The pooled percentages of HCC for CT, ECA-MRI, and Gx-MRI, respectively, were 10%, 6%, and 1% for LR-2 (P = .16); 48%, 31%, and 38% for LR-3 (P = .42); 76%, 64%, and 77% for LR-4 (P = .62); 96%, 95%, and 96% for LR-5 (P = .76); 88%, 76%, and 78% for LR-5V or LR-TIV (tumor in vein) (P = .42); and 20%, 30%, and 35% for LR-M (P = .32). Most LR-M (93%-100%) and LR-5V or LR-TIV (99%-100%) observations were malignant, regardless of modality. Conclusion There was no difference in percentages of hepatocellular carcinoma and overall malignancy between CT, MRI with extracellular contrast agents, and MRI with gadoxetate for any Liver Imaging Reporting and Data System categories. © RSNA, 2023 Supplemental material is available for this article See also the editorial by Ronot in this issue.
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Affiliation(s)
- Sunyoung Lee
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Yeun-Yoon Kim
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Jaeseung Shin
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Won Jeong Son
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Yun Ho Roh
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Jin-Young Choi
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Claude B Sirlin
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Victoria Chernyak
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
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Yoon J, Park SH, Ahn SJ, Shim YS. Atypical Manifestation of Primary Hepatocellular Carcinoma and Hepatic Malignancy Mimicking Lesions. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:808-829. [PMID: 36238905 PMCID: PMC9514587 DOI: 10.3348/jksr.2021.0178] [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: 11/15/2021] [Revised: 12/27/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively on multiphasic CT and MRI based on its distinctive imaging findings. These features include arterial phase hyperenhancement and washout on portal or delayed phase images. However, radiologists face significant diagnostic challenges because some HCCs exhibit atypical imaging characteristics. In addition to many HCC-mimicking lesions, such as arterioportal shunts, combined HCC-cholangiocarcinoma, intrahepatic cholangiocarcinoma, and hemangioma present a challenge for radiologists in actual clinical practice. The ability to distinguish HCCs from mimickers on initial imaging examinations is crucial for appropriate management and treatment decisions. Therefore, this pictorial review presents the imaging findings of atypical HCCs and HCCs mimicking malignant and benign lesions and discusses important clues that may help narrow down the differential diagnosis.
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New strategy for Liver Imaging Reporting and Data System category M to improve diagnostic performance of MRI for hepatocellular carcinoma ≤ 3.0 cm. Abdom Radiol (NY) 2022; 47:2289-2298. [PMID: 35523888 DOI: 10.1007/s00261-022-03538-w] [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: 11/18/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE We aimed to determine a new strategy for Liver Imaging Reporting and Data System category M (LR-M) criteria to improve the diagnosis of HCC ≤ 3.0 cm on magnetic resonance imaging (MRI). METHODS A total of 463 pathologically confirmed hepatic observations ≤ 3.0 cm (375 HCCs, 32 other malignancies, 56 benignities) in 384 patients at risk of HCC who underwent gadoxetate-enhanced MRI were retrospectively analyzed. Two radiologists evaluated the presence of major, ancillary, and LR-M features according to LI-RADS v2018. Of the ten LR-M features, those significantly associated with non-HCC malignancy were identified using multivariable logistic regression analysis, and new LR-M criteria for improving the diagnosis of HCC were investigated. Generalized estimating equations were used to compare sensitivity and specificity of LR-5 for diagnosing HCC using the new LR-M criteria with values calculated using the original LR-M criteria. p < 0.05 was considered to indicate a significant difference. RESULTS Of ten LR-M features, rim arterial-phase hyperenhancement, delayed central enhancement, targetoid restriction, and targetoid transitional-phase/hepatobiliary-phase appearance were independently significantly associated with non-HCC malignancy (adjusted odds ratio ≥ 6.2; p ≤ 0.02). Using the new LR-M criteria (two or more of these significant features), the sensitivity of LR-5 for diagnosing HCC was higher than that with the original LR-M criteria (69% [95% confidence interval 64-73%] vs. 65% [61-70%], p = 0.002), whereas the specificity was similar (90% [82-95%] vs. 92% [83-96%], p = 0.28). CONCLUSION The new LR-M criteria (two or more significant features) can improve the sensitivity of LR-5 for diagnosing HCC ≤ 3.0 cm, without compromising specificity.
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Zhang H, Guo D, Liu H, He X, Qiao X, Liu X, Liu Y, Zhou J, Zhou Z, Liu X, Fang Z. MRI-Based Radiomics Models to Discriminate Hepatocellular Carcinoma and Non-Hepatocellular Carcinoma in LR-M According to LI-RADS Version 2018. Diagnostics (Basel) 2022; 12:diagnostics12051043. [PMID: 35626199 PMCID: PMC9139717 DOI: 10.3390/diagnostics12051043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
Differentiating hepatocellular carcinoma (HCC) from other primary liver malignancies in the Liver Imaging Reporting and Data System (LI-RADS) M (LR-M) tumours noninvasively is critical for patient treatment options, but visual evaluation based on medical images is a very challenging task. This study aimed to evaluate whether magnetic resonance imaging (MRI) models based on radiomics features could further improve the ability to classify LR-M tumour subtypes. A total of 102 liver tumours were defined as LR-M by two radiologists based on LI-RADS and were confirmed to be HCC (n = 31) and non-HCC (n = 71) by surgery. A radiomics signature was constructed based on reproducible features using the max-relevance and min-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) logistic regression algorithms with tenfold cross-validation. Logistic regression modelling was applied to establish different models based on T2-weighted imaging (T2WI), arterial phase (AP), portal vein phase (PVP), and combined models. These models were verified independently in the validation cohort. The area under the curve (AUC) of the models based on T2WI, AP, PVP, T2WI + AP, T2WI + PVP, AP + PVP, and T2WI + AP + PVP were 0.768, 0.838, 0.778, 0.880, 0.818, 0.832, and 0.884, respectively. The combined model based on T2WI + AP + PVP showed the best performance in the training cohort and validation cohort. The discrimination efficiency of each radiomics model was significantly better than that of junior radiologists’ visual assessment (p < 0.05; Delong). Therefore, the MRI-based radiomics models had a good ability to discriminate between HCC and non-HCC in LR-M tumours, providing more options to improve the accuracy of LI-RADS classification.
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Affiliation(s)
- Haiping Zhang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Huan Liu
- GE Healthcare, Shanghai 201203, China;
| | - Xiaojing He
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Xiaofeng Qiao
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Xinjie Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Yangyang Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Jun Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Zhiming Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Xi Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
| | - Zheng Fang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.Z.); (D.G.); (X.H.); (X.Q.); (X.L.); (Y.L.); (J.Z.); (Z.Z.); (X.L.)
- Correspondence: ; Tel.: +86-23-63693238
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LI-RADS Version 2018 Targetoid Appearances on Gadoxetic Acid-Enhanced MRI: Interobserver Agreement and Diagnostic Performance for the Differentiation of HCC and Non-HCC Malignancy. AJR Am J Roentgenol 2022; 219:421-432. [PMID: 35319906 DOI: 10.2214/ajr.22.27380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In LI-RADS version 2018, observations showing at least one of five targetoid appearances on different sequences or postcontrast phases are assigned LR-M, indicating likely non-hepatocellular carcinoma (HCC) malignancy. Objective: To evaluate interobserver agreement of the LI-RADS targetoid appearances among a large number of radiologists of varying experiences, and the targetoid appearances' diagnostic performance for differentiating HCC from non-HCC malignancy. Methods: This retrospective study included 100 patients (76 men, 24 women; mean age, 58±9 years) at high-risk for HCC who underwent gadoxetic acid-enhanced MRI within 30 days before hepatic tumor resection [25 randomly selected patients with non-HCC malignancy (13 intrahepatic cholangiocarcinoma, 12 combined HCC-cholangiocarcinoma); 75 matched patients with HCC]. Eight radiologists [four more-experienced (8-15 years); four less-experienced (1-5 years)] from seven different institutions independently assessed observations for the five targetoid appearances and LI-RADS categorization. Interobserver agreement and diagnostic performance for non-HCC malignancy were evaluated. Results: Interobserver agreement was poor for peripheral washout (κ=0.20); moderate for targetoid transitional-phase or hepatobiliary-phase appearance (κ=0.33), delayed central enhancement (κ=0.37), and targetoid restriction (κ=0.43); and substantial for rim arterial-phase hyperenhancement (κ=0.61). Agreement was fair for at least one targetoid appearance (κ=0.36) and moderate for at least two, three, or four targetoid appearances (κ=0.43-0.51). Agreement for individual targetoid appearances was not significantly different between more-experienced and less-experienced readers other than for targetoid restriction (κ=0.63 vs 0.43; p=.001). Agreement for at least one targetoid appearance was fair among more-experienced (κ=0.29) and less-experienced (κ=0.37) reviewers. Agreement for at least two, three, or four targetoid appearances was moderate-to-substantial among more-experienced reviewers (κ=0.45-0.63) and moderate among less-experienced reviewers (κ=0.42-0.56). Existing LR-M criteria of at least one targetoid appearance had median accuracy for non-HCC malignancy of 62%, sensitivity of 84%, and specificity of 54%. For all reviewers, accuracy was highest when requiring at least three (median accuracy 79%, sensitivity 68%, specificity 82%) or four (median accuracy 80%, sensitivity 54%, specificity 88%) targetoid appearances. Conclusion: Targetoid appearances and LR-M categorization exhitibted considerable interobserver variation for both more- and less-experienced reviewers. Clinical Impact: Requirement for multiple targetoid appearances for LR-M categorization improved interobserver agreement and diagnostic accuracy for non-HCC malignancy.
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LR-M Observations on Contrast-Enhanced Ultrasound: Detection of Hepatocellular Carcinoma Using Additional Features in Comparison with Current LI-RADS Criteria. AJR Am J Roentgenol 2021; 219:76-85. [PMID: 34910538 DOI: 10.2214/ajr.21.26837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Contrast-enhanced ultrasound (CEUS) LI-RADS assigns category LR-M for observations that are definitely or probably malignant but that are not specific on imaging for hepatocellular carcinoma (HCC). A high percentage of LR-M observations represent HCC. Objective: To retrospectively evaluate the utility of additional features, beyond conventional LI-RADS major features, for detecting HCC among LR-M observations on CEUS. Methods: This retrospective study included 174 patients (145 men, 29 women; mean age, 53 years) at high-risk for HCC who underwent CEUS from August 2014 to June 2016, demonstrating an LR-M observation using CEUS LI-RADS version 2017. Two radiologists independently assessed CEUS images for major features and four additional features (chaotic vessels, peripheral circular artery, clear boundary of the tumor enhancement, clear boundary of the intratumoral nonenhanced area). Diagnostic performance was assessed of four proposed criteria for the detection of HCC among LR-M observations. The impact on HCC detection of criteria based on the additional findings was further explored. Histology or composite imaging and clinical follow-up served as reference standard. Results: The 174 LR-M observations included 142 HCCs and 32 non-HCCs (20 intrahepatic cholangiocarcinomas, 5 combined hepatocellular-cholangiocarcinomas, 7 benign lesions). Interreader agreement of the additional features, expressed as kappa, ranged from 0.65 to 0.88. Two of the additional features exhibited PPV ≥95.0% for HCC: chaotic vessels (95.0%) and peripheral circular arteries (98.1%). The presence of either of these two additional features achieved sensitivity of 50.7%, specificity of 90.6%, PPV of 96.0%, and NPV of 29.3% for HCC. Three other explored criteria incorporating variations of major LI-RADS features, but not the additional features, had sensitivities of 55.6%-96.5%, specificities of 49.6%-68.8%, PPVs of 87.8%-90.6%, and NPVs of 25.0%-75.0%. Criteria using additional features recategorized 75 of 174 LR-M observations as LR-5, of which 72 were HCC. Conclusion: The presence of chaotic vessels and/or peripheral circular artery had high specificity and PPV for HCC among LR-M observations. Other explored criteria based on major features did not achieve higher specificity or PPV. Clinical Impact: Clinical adoption of the additional CEUS features could help establish the diagnosis of HCC noninvasively and avoid the need for biopsy of LR-M observations.
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Fowler KJ, Burgoyne A, Fraum TJ, Hosseini M, Ichikawa S, Kim S, Kitao A, Lee JM, Paradis V, Taouli B, Theise ND, Vilgrain V, Wang J, Sirlin CB, Chernyak V. Pathologic, Molecular, and Prognostic Radiologic Features of Hepatocellular Carcinoma. Radiographics 2021; 41:1611-1631. [PMID: 34597222 DOI: 10.1148/rg.2021210009] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a malignancy with variable biologic aggressiveness based on the tumor grade, presence or absence of vascular invasion, and pathologic and molecular classification. Knowledge and understanding of the prognostic implications of different pathologic and molecular phenotypes of HCC are emerging, with therapeutics that promise to provide improved outcomes in what otherwise remains a lethal cancer. Imaging has a central role in diagnosis of HCC. However, to date, the imaging algorithms do not incorporate prognostic features or subclassification of HCC according to its biologic aggressiveness. Emerging data suggest that some imaging features and further radiologic, pathologic, or radiologic-molecular phenotypes may allow prediction of the prognosis of patients with HCC. An invited commentary by Bashir is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kathryn J Fowler
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Adam Burgoyne
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Tyler J Fraum
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Mojgan Hosseini
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Shintaro Ichikawa
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Sooah Kim
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Azusa Kitao
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Jeong Min Lee
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Valérie Paradis
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Bachir Taouli
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Neil D Theise
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Valérie Vilgrain
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Jin Wang
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Claude B Sirlin
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
| | - Victoria Chernyak
- From the Departments of Radiology (K.J.F., C.B.S.), Medicine (A.B.), and Pathology (M.H.), University of California San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92103; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan (S.I.); Departments of Radiology (S.K.) and Pathology (N.D.T.), New York University Grossman School of Medicine, New York, NY; Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan (A.K.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Service d'Anatomie Pathologique, Université de Paris, Hôpital Beaujon APHP, Clichy, France (V.P.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); Université de Paris, INSERM U1149 "Centre de Recherche sur l'Inflammation," Paris, France (V.V.); Department of Radiology, AP-HP, Hôpital Beaujon APHP Nord, Clichy, France (V.V.); Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.W.); and Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.)
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15
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Min JH, Kim JM, Kim YK, Kim H, Choi GS, Kang TW, Cha D, Hwang JA, Ko SE, Ahn S. A modified LI-RADS: targetoid tumors with enhancing capsule can be diagnosed as HCC instead of LR-M lesions. Eur Radiol 2021; 32:912-922. [PMID: 34345947 DOI: 10.1007/s00330-021-08124-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To elucidate whether the presence of enhancing capsule can be applied to establish a modified Liver Imaging Reporting and Data System (LI-RADS) to differentiate hepatocellular carcinoma (HCC) from non-HCC malignancies in extracellular contrast agent (ECA)-enhanced and hepatobiliary agent (HBA)-enhanced MRI. METHODS We enrolled 198 participants (161 men; mean age, 56.3 years) with chronic liver disease who underwent ECA-MRI and HBA-MRI before surgery for de novo hepatic nodule(s). Two reviewers assigned LI-RADS categories (v2018). We defined a "modified LR-5 category, which emphasizes enhancing capsule (mLR-5C)" over targetoid features and classifies tumors with both targetoid appearance and enhancing capsule as HCC instead of LR-M. We compared the diagnostic performance of conventional LI-RADS and modified LI-RADS criteria for both MRIs. RESULTS A total of 258 hepatic nodules (194 HCCs, 43 benign lesions, and 21 non-HCC malignancies; median size, 19 mm) were analyzed. By conventional LI-RADS, 47 (18.2%) nodules (31 HCCs and 16 non-HCC malignancies) were categorized as LR-M. The mLR-5C criterion showed superior sensitivity (ECA-MRI, 76.6% vs. 67.0%; HBA-MRI, 60.4% vs. 56.3%; both p < 0.05) while maintaining high specificity (ECA-MRI, 93.8% vs. 98.4%; HBA-MRI, 95.3% vs. 98.4%; both p > 0.05) compared with the LR-5 criterion. Using the mLR-5C criterion, ECA-MRI exhibited higher sensitivity than HBA-MRI (76.6% vs. 60.4%, p < 0.001) and similar specificity (93.8% vs. 95.3%, p > 0.99). CONCLUSION Our modified LI-RADS achieved superior sensitivity for diagnosing HCC, without compromising specificity compared with LR-5. ECA-MRI showed higher sensitivity in diagnosing HCC than HBA-MRI by applying the mLR-5C for LR-M lesions. KEY POINTS • By conventional LI-RADS, 31 (16.0%) of 194 HCCs were categorized as LR-M. • Among 31 HCCs categorized as LR-M, 19 HCCs or 8 HCCs were recategorized as HCC on ECA-MRI or HBA-MRI, respectively, after applying the modified LR-5 category, which allocates targetoid lesions with enhancing capsule as mLR-5C instead of LR-M. • The mLR-5C showed superior sensitivity compared with the LR-5 in both MRIs (ECA-MRI, 76.6% vs. 67.0%; HBA-MRI, 60.4% vs. 56.3%, both p < 0.05), while maintaining high specificity (ECA-MRI, 93.8% vs. 98.4%; HBA-MRI, 95.3% vs. 98.4%; both p > 0.05).
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Honsoul Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gyu Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dongik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seong Eun Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
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Huang Z, Zhou P, Li S, Li K. MR versus CEUS LI-RADS for Distinguishing Hepatocellular Carcinoma from other Hepatic Malignancies in High-Risk Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1244-1252. [PMID: 33610338 DOI: 10.1016/j.ultrasmedbio.2021.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Distinguishing between other hepatic malignancies (OMs) and hepatocellular carcinoma (HCC) is vital to allow clinicians to determine optimal treatment and assess prognosis in patients at high risk for HCC. This study evaluated the performance of the Liver Imaging Reporting and Data System (LI-RADS) using magnetic resonance imaging (MRI) versus contrast-enhanced ultrasonography (CEUS) for differentiating HCC from OMs in patients at high risk for HCC. This retrospective study consecutively enrolled 106 high-risk patients with HCC and 52 high-risk patients with OMs. Patients underwent both MRI and CEUS, with histologic diagnosis as a reference standard. The diagnostic performance of MR versus CEUS LI-RADS was calculated and compared. The performance of the modified CEUS LI-RADS criteria was also evaluated and compared. Our research found that MRI features significantly differed between patients with OMs and those with HCC (p < 0.05), with sensitivities of 34.6%-69.2% and specificities of 83.0%-95.3% for diagnosing OMs and an LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma sensitivity of 90.4% and specificity of 83.0% for diagnosing OM. CEUS features also significantly differed between patients with OM and HCC (p < 0.05), with sensitivities of 11.5%-96.2% and specificities of 23.6%-100% for diagnosing OMs, and an LR-M sensitivity of 98.1% and specificity of 84.0% for diagnosing OMs. Accuracies of category LR-M did not significantly differ between MR and CEUS LI-RADS (85.4% vs. 88.6%, p = 0.724). After reclassification of category LR-M nodules to category LR-5 if they exhibited clear intratumoral non-enhanced area boundaries and no punched-out appearance before 5 min, accuracy increased from 88.6% to 96.8% for CEUS LR-M and from 84.8% to 91.1% for CEUS LR-5. LR-M accuracies were significantly higher for the modified version of the CEUS LI-RADS than for MR LI-RADS (96.8% vs. 85.4%, respectively, p = 0.04). CEUS LI-RADS and MR LI-RADS can effectively be used to distinguish HCC from OMs. In patients at high risk of HCC, performance may be further improved by using a modified CEUS LI-RADS classification system in which category LR-M lesions are considered LR-5 if they have clear intratumoral non-enhanced area boundaries and do not have a punched-out appearance.
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - PingPing Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShanShan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Shin J, Lee S, Kim SS, Chung YE, Choi JY, Park MS, Kim MJ. Characteristics and Early Recurrence of Hepatocellular Carcinomas Categorized as LR-M: Comparison with Those Categorized as LR-4 or 5. J Magn Reson Imaging 2021; 54:1446-1454. [PMID: 33891790 DOI: 10.1002/jmri.27650] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND According to the Liver Imaging Reporting and Data System (LI-RADS), the LI-RADS category M (LR-M), which are probably or definitely malignant but are not specific for hepatocellular carcinomas (HCCs), does not exclude HCCs. A gap in knowledge remains, including their characteristics and recurrence of HCCs categorized as LR-M. PURPOSE To compare the characteristics of HCCs categorized as LR-M with HCCs categorized as LR-4 or LR-5 (LR-4/5) using the LI-RADS version 2018 and evaluate the relationship of these categories with the risk of early recurrence after curative resections of single HCCs. STUDY TYPE Retrospective. SUBJECTS Two hundred and eighty-one patients (mean age, 57 years; 191 men and 90 women) who underwent curative resections for single HCCs and preoperative contrast-enhanced MRI between 2015 and 2017. FIELD STRENGTH/SEQUENCE 3T Dual gradient-echo T1 WI with in- and opposed-phase, turbo spin-echo T2 WI, diffusion-weighted echo-planar images, and three-dimensional gradient-echo T1 WI before and after administration of contrast agent. ASSESSMENT MRI features according to the LI-RADS version 2018 were evaluated and LI-RADS category were assigned for each observation. Clinical, imaging, and histopathological features were compared based on LI-RADS categorization. Early recurrence rates (<2 years) and associated factors were also evaluated. STATISTICAL TESTS Fisher's exact test, two-sample t test after satisfying assumption of normality through Shapiro-Wilk test, Fleiss κ coefficient, Cox proportional hazards regression analysis, Kaplan-Meier method, and log-rank test. RESULTS Forty-one HCCs (14.6%) were categorized as LR-M and 240 HCCs (85.4%) were categorized as LR-4/5. LR-M HCCs showed poorer differentiation than LR-4/5 HCCs. In the multivariate analysis, the LR-M category was an independent predictor for early recurrence (hazard ratio, 1.904; 95% confidence interval, 1.024-3.542; P < 0.05). Early recurrence rates were significantly higher in patients with LR-M HCCs than in patients with LR-4/5 HCCs (32.0% vs. 18.4%, respectively, P < 0 05). DATA CONCLUSION Compared to LR-4/5 HCCs, LR-M HCCs were associated with poorer tumor differentiation and higher early recurrence rates after curative resections of single HCCs. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 2.
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Affiliation(s)
- Jaeseung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Seob Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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