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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

  • Hepatobiliary
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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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Abbreviations

APHE:

Arterial-phase hyperenhancement

CCA:

Intrahepatic cholangiocarcinoma

cHCC-CCA:

Combined hepatocellular-cholangiocarcinoma

CT:

Computed tomography

HBP:

Hepatobiliary-phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

TP:

Transitional phase

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Acknowledgements

This study was financially supported by Bayer Korea, but the authors had complete control of the data and information submitted for publication at all times.

Funding

This study was financially supported by Bayer Korea, but the authors had complete control of the data and information submitted for publication at all times.

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Author notes

  1. Jong Keon Jang and Sang Hyun Choi shared co-first authorship.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Jong Keon Jang, Sang Hyun Choi, Jae Ho Byun, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin & Pyo-Nyun Kim

  2. Department of Statistics and Data Science, Korea National Open University, Main Building 320, 86 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea

    Seo Young Park

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Correspondence to Jae Ho Byun.

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Conflict of interest

Sang Hyun Choi is an advisory board member of Bayer Korea and receives research funding from Bayer Korea, but the authors had complete control of the data and information submitted for publication at all times. The other authors have nothing to declare.

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This retrospective study was approved by institutional review board of Asan Medical Center (IRB No. 2019-1556).

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Jang, J.K., Choi, S.H., Byun, J.H. et al. 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 47, 2289–2298 (2022). https://doi.org/10.1007/s00261-022-03538-w

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