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Evaluation of treatment response in hepatocellular carcinoma in the explanted liver with Liver Imaging Reporting and Data System version 2017

  • Nieun Seo
  • Myoung Soo Kim
  • Mi-Suk ParkEmail author
  • Jin-Young Choi
  • Richard K. G. Do
  • Kyunghwa Han
  • Myeong-Jin Kim
Gastrointestinal

Abstract

Objective

To investigate the performance of Liver Imaging Reporting and Data System (LI-RADS) v2017 treatment response algorithm for predicting hepatocellular carcinoma (HCC) viability after locoregional therapy (LRT) using the liver explant as reference.

Methods

One hundred fourteen patients with 206 HCCs who underwent liver transplantation (LT) after LRT for HCCs were included in this retrospective study. Two radiologists independently evaluated tumor viability using the LI-RADS and modified RECIST (mRECIST) with CT and MRI, respectively. The sensitivity and specificity of arterial phase hyperenhancement (APHE) and LR-TR viable criteria (any of three findings: APHE, washout, and enhancement pattern similar to pretreatment imaging) were compared using logistic regression. Receiver operating characteristics (ROC) analysis was used to compare the diagnostic performance between LI-RADS and mRECIST and between CT and MRI.

Results

The sensitivity and specificity for diagnosing viable tumor were not significantly different between APHE alone and LR-TR viable criteria on CT (p = 0.054 and p = 0.317) and MRI (p = 0.093 and p = 0.603). On CT, the area under the ROC curve (AUC) of LI-RADS was significantly higher than that of mRECIST (0.733 vs. 0.657, p < 0.001). On MRI, there was no significant difference in AUCs between LI-RADS and mRECIST (0.802 vs. 0.791, p = 0.500). Intra-individual comparison of CT and MRI showed comparable AUCs using LI-RADS (0.783 vs. 0.795, p = 0.776).

Conclusions

LI-RADS v2017 treatment response algorithm showed better diagnostic performance than mRECIST on CT. With LI-RADS, CT and MRI were comparable to diagnose tumor viability of HCC after LRT.

Key Points

Using Liver Imaging Reporting and Data System (LI-RADS) v2017 treatment response algorithm, the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) can be accurately diagnosed.

LI-RADS v2017 treatment response algorithm is superior to modified Response Evaluation Criteria in Solid Tumors for evaluating HCC viability using CT.

Either CT or MRI can be performed to assess tumor viability after LRT using LI-RADS v2017 treatment response algorithm.

Keywords

Liver transplantation Hepatocellular carcinoma Multidetector computed tomography Magnetic resonance imaging Therapeutic chemoembolization 

Abbreviations

APHE

Arterial phase hyperenhancement

CT

Computed tomography

EASL

European Association for the Study of the Liver

GEE

Generalized estimating equation

HCC

Hepatocellular carcinoma

LI-RADS

Liver Imaging Reporting and Data System

LRT

Locoregional therapy

LT

Liver transplantation

mRECIST

Modified Response Criteria in Solid Tumors

MRI

Magnetic resonance imaging

PACS

Picture archiving and communication system

RFA

Radiofrequency ablation

TACE

Transarterial chemoembolization

WHO

World Health Organization

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Mi-Suk Park.

Conflict of interest

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.

Statistics and biometry

Kyunghwa Han performed statistical analysis, who is one of the coauthors.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2019_6376_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of SurgeryYonsei University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Radiology, Research Institute of Radiological ScienceYonsei Biomedical Research InstituteSeoulSouth Korea

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