Abstract
Purpose
We aimed to determine a new strategy for Liver Imaging Reporting and Data System category M (LR-M) criteria to improve the diagnosis of HCC ≤ 3.0 cm on magnetic resonance imaging (MRI).
Methods
A total of 463 pathologically confirmed hepatic observations ≤ 3.0 cm (375 HCCs, 32 other malignancies, 56 benignities) in 384 patients at risk of HCC who underwent gadoxetate-enhanced MRI were retrospectively analyzed. Two radiologists evaluated the presence of major, ancillary, and LR-M features according to LI-RADS v2018. Of the ten LR-M features, those significantly associated with non-HCC malignancy were identified using multivariable logistic regression analysis, and new LR-M criteria for improving the diagnosis of HCC were investigated. Generalized estimating equations were used to compare sensitivity and specificity of LR-5 for diagnosing HCC using the new LR-M criteria with values calculated using the original LR-M criteria. p < 0.05 was considered to indicate a significant difference.
Results
Of ten LR-M features, rim arterial-phase hyperenhancement, delayed central enhancement, targetoid restriction, and targetoid transitional-phase/hepatobiliary-phase appearance were independently significantly associated with non-HCC malignancy (adjusted odds ratio ≥ 6.2; p ≤ 0.02). Using the new LR-M criteria (two or more of these significant features), the sensitivity of LR-5 for diagnosing HCC was higher than that with the original LR-M criteria (69% [95% confidence interval 64–73%] vs. 65% [61–70%], p = 0.002), whereas the specificity was similar (90% [82–95%] vs. 92% [83–96%], p = 0.28).
Conclusion
The new LR-M criteria (two or more significant features) can improve the sensitivity of LR-5 for diagnosing HCC ≤ 3.0 cm, without compromising specificity.
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Abbreviations
- APHE:
-
Arterial-phase hyperenhancement
- CCA:
-
Intrahepatic cholangiocarcinoma
- cHCC-CCA:
-
Combined hepatocellular-cholangiocarcinoma
- CT:
-
Computed tomography
- HBP:
-
Hepatobiliary-phase
- HCC:
-
Hepatocellular carcinoma
- LI-RADS:
-
Liver Imaging Reporting and Data System
- MRI:
-
Magnetic resonance imaging
- NPV:
-
Negative predictive value
- OR:
-
Odds ratio
- PPV:
-
Positive predictive value
- TP:
-
Transitional phase
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Acknowledgements
This study was financially supported by Bayer Korea, but the authors had complete control of the data and information submitted for publication at all times.
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This study was financially supported by Bayer Korea, but the authors had complete control of the data and information submitted for publication at all times.
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Sang Hyun Choi is an advisory board member of Bayer Korea and receives research funding from Bayer Korea, but the authors had complete control of the data and information submitted for publication at all times. The other authors have nothing to declare.
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This retrospective study was approved by institutional review board of Asan Medical Center (IRB No. 2019-1556).
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Jang, J.K., Choi, S.H., Byun, J.H. et al. New strategy for Liver Imaging Reporting and Data System category M to improve diagnostic performance of MRI for hepatocellular carcinoma ≤ 3.0 cm. Abdom Radiol 47, 2289–2298 (2022). https://doi.org/10.1007/s00261-022-03538-w
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DOI: https://doi.org/10.1007/s00261-022-03538-w