Abstract
Objective
This study was conducted in order to assess the diagnostic accuracy of LI-RADS v2018 ancillary features (AFs) favoring malignancy applied to LR-3 and LR-4 observations on gadoxetate-enhanced MRI.
Methods
In this retrospective dual-institution study, we included consecutive patients at high risk for hepatocellular carcinoma (HCC) imaged with gadoxetate disodium-enhanced MRI between 2009 and 2014 fulfilling the following criteria: (i) at least one LR-3 or LR-4 observation ≥ 10 mm; (ii) nonrim arterial phase hyperenhancement; and (iii) confirmation of benignity or malignancy by pathology or imaging follow-up. We compared the distribution of AFs between HCCs and benign observations and the diagnostic performance for the diagnosis of HCC using univariate and multivariate analyses. Significance was set at p value < 0.05.
Results
Two hundred five observations were selected in 155 patients (108 M, 47 F) including 167 (81.5%) LR-3 and 38 (18.5%) LR-4. There were 126 (61.5%) HCCs and 79 (28.5%) benign lesions. A significantly larger number of AFs favoring malignancy were found in LR-3 and LR-4 lesions that progressed to HCC compared to benign lesions (p < 0.001 and p = 0.003, respectively). The most common AFs favoring malignancy in HCCs were hepatobiliary phase (HBP) hypointensity (p < 0.001), transitional phase hypointensity (p < 0.001), and mild–moderate T2 hyperintensity (p < 0.001). Sensitivity and specificity of AFs for the diagnosis of HCC ranged 0.8–76.2% and 86.1–100%, respectively. HBP hypointensity yielded the highest sensitivity but also the lowest specificity and was the only AF remaining independently associated with the diagnosis of HCC at multivariate logistic regression analysis (OR 14.83, 95% CI 5.81–42.76, p < 0.001).
Conclusions
Among all AFs, HBP hypointensity yields the highest sensitivity for the diagnosis of HCC.
Key Points
• LR-3 and LR-4 observations diagnosed as HCC have a significantly higher number of ancillary features favoring malignancy compared to observations proven to be benign.
• The presence of three or more ancillary features favoring malignancy has a high specificity (96.2%) for the diagnosis of HCC.
• Among all ancillary features favoring malignancy, hepatobiliary phase hypointensity yields the highest sensitivity, but also the lowest specificity for the diagnosis of HCC.
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Abbreviations
- 3D:
-
Three-dimensional
- AFs:
-
Ancillary features
- AP:
-
Arterial phase
- APHE:
-
Arterial phase hyperenhancement
- AUC:
-
Area-under-the-curve
- DWI:
-
Diffusion-weighted images
- FSE:
-
Fast spin echo
- GRE:
-
Gradient-recalled echo
- HBP:
-
Hepatobiliary phase
- HCC:
-
Hepatocellular carcinoma
- IQR:
-
Interquartile range
- LI-RADS:
-
Liver Imaging Reporting and Data System
- MRI:
-
Magnetic resonance imaging
- NPV:
-
Negative predictive values
- OATP:
-
Organic anion transporting polypeptide
- PPV:
-
Positive predictive value
- PVP:
-
Portal venous phase
- ROC:
-
Receiver operating characteristic
- TP:
-
Transitional phase
- VIBE:
-
Volumetric interpolated breath-hold examination
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The scientific guarantor of this publication is Alessandro Furlan.
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The authors of this manuscript declare relationships with the following companies: Daniele Marin: research support from Siemens Healthineers; and Alessandro Furlan: royalties from Elsevier/Amirsys and consultant for Bracco.
Statistics and biometry
Two of the authors (Hersh Sagreiya and Kingshuk Roy Choudhury) have significant statistical expertise.
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Written informed consent was waived by the Institutional Review Board.
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Study subjects or cohorts overlap
We would like to specify that 104/155 patients were included in a previous study (title: LI-RADS: diagnostic performance of hepatobiliary phase hypointensity and major imaging features of LR-3 and LR-4 lesions measuring 10–19 mm with arterial phase hyperenhancement) where we reported the diagnostic performance of the HBP hypointensity and major features in LR-3 and LR-4 observations with APHE measuring 10–19 mm and classified according to LI-RADS v2017. Conversely, in this study, we aim at investigating the diagnostic performance of all AFs favoring malignancy, not only HBP hypointensity, for the diagnosis of HCC using the LI-RADS v2018.
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• Retrospective
• Diagnostic or prognostic study
• Multicenter study
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Cannella, R., Vernuccio, F., Sagreiya, H. et al. Liver Imaging Reporting and Data System (LI-RADS) v2018: diagnostic value of ancillary features favoring malignancy in hypervascular observations ≥ 10 mm at intermediate (LR-3) and high probability (LR-4) for hepatocellular carcinoma. Eur Radiol 30, 3770–3781 (2020). https://doi.org/10.1007/s00330-020-06698-9
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DOI: https://doi.org/10.1007/s00330-020-06698-9