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How to utilize LR-M features of the LI-RADS to improve the diagnosis of combined hepatocellular-cholangiocarcinoma on gadoxetate-enhanced MRI?

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To investigate the diagnostic accuracy of each LR-M feature defined in version 2017 of the Liver Imaging Reporting and Data System (LI-RADS) and determine the optimal LR-M feature for differentiating combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and hepatocellular carcinoma (HCC) on gadoxetate-enhanced magnetic resonance imaging (MRI).

Methods

Ninety-nine patients with pathologically proven cHCC-CCA (n = 33) or HCC (n = 66) after surgery were identified. Two radiologists retrospectively assessed preoperative gadoxetate-enhanced MRI for features favoring non-HCC malignancies (LR-M features) according to LI-RADS version 2017. Multivariate logistic regression analysis was performed to determine the independent differential features. The sensitivity and specificity for diagnosing cHCC-CCA were calculated for each LR-M feature.

Results

Targetoid appearance showed the highest sensitivity (75.8%, 95% confidence interval [CI] 60.6%, 87.3%) to correctly identify cHCC-CCA as LR-M. At least one LR-M feature was observed in 31 (93.9%) patients with cHCC-CCA and 34 (51.5%) patients with HCC. The sensitivity and specificity for diagnosing cHCC-CCA using the presence of any one of the LR-M features were 93.9% (95% CI 80.7, 98.9) and 48.5% (95% CI 41.9, 51.0), respectively. The presence of three LR-M features yielded the highest diagnostic accuracy of 80.8% (95% CI 72.1, 86.1) with a reduced sensitivity of 54.5% (95% CI 41.4, 62.5).

Conclusion

The majority of cHCC-CCA cases can be properly categorized as LR-M when any one of the LR-M features defined in the LI-RADS version 2017 is used as a determiner. However, approximately half of HCC cases also show at least one LR-M feature.

Key Points

• Targetoid appearance, including rim APHE, peripheral “washout” appearance, and delayed central enhancement, was the LR-M feature that identified cHCC-CCA as a non-HCC malignancy with the highest sensitivity.

• Most cHCC-CCA cases can be properly categorized as LR-M when the presence of any one of the LR-M features was used as the determiner.

• Approximately half of HCC cases also showed at least one LR-M feature.

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Abbreviations

APHE:

Arterial phase hyperenhancement

cHCC-CCA:

Combined hepatocellular-cholangiocarcinoma

DW:

Diffusion-weighted

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS v2017:

Liver Imaging Reporting and Data System version 2017

LR-M:

Tumors with imaging features of malignancy that are not specific for HCC

MRI:

Magnetic resonance imaging

TE:

Echo time

TR:

Repetition time

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Hong Seon Lee, Myeong-Jin Kim & Chansik An

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  1. Hong Seon Lee
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  2. Myeong-Jin Kim
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Correspondence to Myeong-Jin Kim.

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The scientific guarantor of this publication is Myeong-Jin Kim.

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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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Written informed consent was waived by the Institutional Review Board.

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Methodology

• retrospective

• case-control study

• performed at one institution

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Lee, H.S., Kim, MJ. & An, C. How to utilize LR-M features of the LI-RADS to improve the diagnosis of combined hepatocellular-cholangiocarcinoma on gadoxetate-enhanced MRI?. Eur Radiol 29, 2408–2416 (2019). https://doi.org/10.1007/s00330-018-5893-1

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  • DOI: https://doi.org/10.1007/s00330-018-5893-1

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