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Diagnostic performance of the LR-M criteria and spectrum of LI-RADS imaging features among primary hepatic carcinomas

  • Hepatobiliary
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Abstract

Purpose

To evaluate the diagnostic performance of LR-M criteria for differentiating hepatocellular carcinoma, intrahepatic mass-forming cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma and to compare the imaging features of each type.

Methods

In this retrospective study, 110 patients were surgically diagnosed with cholangiocarcinoma (n = 67) and combined hepatocellular-cholangiocarcinoma (n = 43) at a single tertiary hospital between 2013 and 2018. Among them, those with risk factors were enrolled (16 cholangiocarcinomas and 33 combined hepatocellular-cholangiocarcinomas). Forty-nine other patients with size-matched hepatocellular carcinoma were selected as a control group. Two independent readers evaluated the imaging findings of the preoperative MRIs based on LI-RADS version 2018 and assigned an LI-RADS category. The diagnostic performance of the LR-M criteria for diagnosing cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma was evaluated, and the imaging features were compared. The imaging findings of the tumors in patients without risk factors (51 cholangiocarcinomas and 10 combined hepatocellular-cholangiocarcinomas) were evaluated for subgroup analysis.

Results

In the non-hepatocellular carcinoma group, 33 patients were categorized into LR-M and 14 patients into LR-5 (67.3% and 28.6%, respectively), while 5 patients with hepatocellular carcinoma were categorized into LR-M and 38 patients into LR-5 (10.2% and 77.6%, respectively). Sensitivity and specificity of the LR-M criteria were 67.3% and 89.8%, respectively. When more than two LR-M features were present, cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma were suggested with a specificity of 95.9%.

Conclusion

The diagnostic performance of the LR-M criteria is acceptable with moderate sensitivity and high specificity for both cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma. Imaging findings of primary hepatic carcinomas should be understood as a spectrum.

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Abbreviations

iCCA:

Intrahepatic cholangiocarcinoma

cHCC-CCA:

Combined hepatocellular and cholangiocarcinoma

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

AFP:

Alpha-fetoprotein

CA:

Carbohydrate antigen

CEA:

Carcinoembryonic antigen

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Authors and Affiliations

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

    Seung-seob Kim, Sunyoung Lee, Jin-Young Choi, Joon Seok Lim, Mi-Suk Park & Myeong-Jin Kim

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  1. Seung-seob Kim
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  2. Sunyoung Lee
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Correspondence to Jin-Young Choi.

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Our institutional review board approved the study (IRB Number: 4-2019-0594); requirement for written informed consent for this retrospective study was waived.

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Our institutional review board approved the study (IRB Number: 4-2019-0594); requirement for written informed consent for this retrospective study was waived.

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Kim, Ss., Lee, S., Choi, JY. et al. Diagnostic performance of the LR-M criteria and spectrum of LI-RADS imaging features among primary hepatic carcinomas. Abdom Radiol 45, 3743–3754 (2020). https://doi.org/10.1007/s00261-020-02562-y

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