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The role of lesion hypointensity on gadobenate dimeglumine–enhanced hepatobiliary phase MRI as an additional major imaging feature for HCC classification using LI-RADS v2018 criteria

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To determine the value of lesion hypointensity in the hepatobiliary phase (HBP) on gadobenate dimeglumine–enhanced MRI as an additional major imaging feature for diagnosis of hepatocellular carcinoma (HCC) using LI-RADS v2018 criteria.

Methods

Between March 2016 and August 2018, 235 patients with 250 hepatic nodules at high risk of HCC underwent gadobenate dimeglumine–enhanced MRI. Two radiologists independently evaluated the imaging features and classified the nodules based on LI-RADS v2018 criteria, and their consensus data were used to calculate the diagnostic performance of LI-RADS categories. Two modified LI-RADS definitions were as follows: (1) LI-RADS-m1: HBP hypointensity as an additional major feature; (2) LI-RADS-m2: HBP hypointensity as an alternative to “enhancing capsule” as an additional major feature. The diagnostic performance of LR-5 categories was compared using McNemar’s test.

Results

The sensitivity and specificity for LR-5 classification using original LI-RADS v2018 criteria were 78.1% and 96.3%, respectively. Significantly improved sensitivity (82.7%; p = 0.004) with unchanged specificity (96.3%; p = 1.00) was seen for LR-5 classification using LI-RADS-m1. Similar sensitivity and specificity (82.7% and 96.3%, respectively) were also seen using LI-RADS-m2. Significantly improved sensitivity (79.5% vs. 64.0%; p = 0.031) with unchanged specificity (96.2% vs. 96.2%, p = 1.00) was seen using both LI-RADS-m1 and LI-RADS-m2 compared to the original LI-RADS v2018 for 39 HCC nodules measuring 10–19 mm.

Conclusions

Lesion hypointensity on gadobenate dimeglumine–enhanced HBP MRI may improve sensitivity for LR-5 classification beyond that achievable using conventional LI-RADS v2018 criteria. Lesion hypointensity may prove a suitable alternative imaging feature to enhancing capsule for accurate LR-5 classification.

Key Points

• Including lesion hypointensity in the HBP as an additional major feature improved sensitivity for LR-5 classification on gadobenate dimeglumine–enhanced MRI.

• Lesion hypointensity in the HBP can replace “enhancing capsule” as an additional major feature for LR-5 classification without impairing specificity.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

APHE:

Arterial hyperenhancement

cHCC-CCA:

Combined hepatocellular-cholangiocarcinoma

ECA:

Extracellular agent

FNR:

False-negative rate

FPR:

False-positive rate

GBCA:

Gadolinium-based contrast agent

Gd-EOB-MRI:

Gadoxetic acid–enhanced MRI

HBP:

Hepatobiliary phase

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HGDNs:

High-grade dysplastic nodules

iCCA:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver Imaging Reporting and Data System

NPV:

Negative predictive value

OATP:

Organic anion-transporting polypeptide

PPV:

Positive predictive value

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Funding

The authors state that this study has received funding from the National Natural Science Foundation of China grant 91959118 (JW), Science and Technology Program of Guangzhou, China grant 201704020016 (JW), SKY Radiology Department International Medical Research Foundation of China Z-2014-07-1912-15 (JW), and Clinical Research Foundation of the 3rd Affiliated Hospital of Sun Yat-sen University YHJH201901 (JW).

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Author notes

  1. Yao Zhang and Wenjie Tang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of China

    Yao Zhang, Wenjie Tang, Sidong Xie, Jingbiao Chen, Linqi Zhang, Dailin Rong, Sichi Kuang, Bingjun He & Jin Wang

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  1. Yao Zhang
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Correspondence to Jin Wang.

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The scientific guarantor of this publication is Jin Wang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Zhang, Y., Tang, W., Xie, S. et al. The role of lesion hypointensity on gadobenate dimeglumine–enhanced hepatobiliary phase MRI as an additional major imaging feature for HCC classification using LI-RADS v2018 criteria. Eur Radiol 31, 7715–7724 (2021). https://doi.org/10.1007/s00330-021-07807-y

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