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Long-term evolution of LR-2, LR-3 and LR-4 observations in HBV-related cirrhosis based on LI-RADS v2018 using gadoxetic acid-enhanced MRI

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope

Abstract

Purpose

To investigate the long-term evolution of LR-2, LR-3 and LR-4 observations in patients with hepatitis B virus (HBV)-related cirrhosis based on LI-RADS v2018 and identify predictors of progression to a malignant category on serial gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI).

Methods

This retrospective study included 179 cirrhosis patients with untreated indeterminate observations who underwent Gd-EOB-MRI exams at baseline and during the follow-up period between June 2016 and December 2021. Two radiologists independently assessed the major features, ancillary features, and LI-RADS category of each observation at baseline and follow-up. In cases of disagreement, a third radiologist was consulted for consensus. Cumulative incidences for progression to a malignant category (LR-5 or LR-M) and to LR-4 or higher were analyzed for each index category using Kaplan‒Meier methods and compared using log-rank tests. The risk factors for malignant progression were evaluated using a Cox proportional hazard model.

Results

A total of 213 observations, including 74 (34.7%) LR-2, 95 (44.6%) LR-3, and 44 (20.7%) LR-4, were evaluated. The overall cumulative incidence of progression to a malignant category was significantly higher for LR-4 observations than for LR-3 or LR-2 observations (each P < 0.001), and significantly higher for LR-3 observations than for LR-2 observations (P < 0.001); at 3-, 6-, and 12-month follow-ups, the cumulative incidence of progression to a malignant category was 11.4%, 29.5%, and 39.3% for LR-4 observations, 0.0%, 8.5%, and 19.6% for LR-3 observations, and 0.0%, 0.0%, and 0.0% for LR-2 observations, respectively. The cumulative incidence of progression to LR-4 or higher was higher for LR-3 observations than for LR-2 observations (P < 0.001); at 3-, 6-, and 12-month follow-ups, the cumulative incidence of progression to LR-4 or higher was 0.0%, 8.5%, and 24.6% for LR-3 observations, and 0.0%, 0.0%, and 0.0% for LR-2 observations, respectively. In multivariable analysis, nonrim arterial phase hyperenhancement (APHE) [hazard ratio (HR) = 2.13, 95% CI 1.04–4.36; P = 0.038], threshold growth (HR = 6.50, 95% CI 2.88–14.65; P <0.001), and HBP hypointensity (HR = 16.83, 95% CI 3.97–71.34; P <0.001) were significant independent predictors of malignant progression.

Conclusion

The higher LI-RADS v2018 categories had an increasing risk of progression to a malignant category during long-term evolution. Nonrim APHE, threshold growth, and HBP hypointensity were the imaging features that were significantly predictive of malignant progression.

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Acknowledgements

A part of these results was presented at the 2023 ISMRM Annual Meeting as an online oral Power Pitch presentation

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Authors and Affiliations

  1. Department of Radiology, Third Affiliated Hospital of Soochow University, No.185 Juqian Street, Tianning District, Changzhou, 213000, Jiangsu, China

    Fei Xing & Wei Xing

  2. Department of Radiology, Third Affiliated Hospital of Nantong University & Nantong Third People’s Hospital, #99 youth middle road, Chongchuan District, Nantong, 226000, Jiangsu, China

    Fei Xing, Tao Zhang, Xiaofen Miao, Jiang Lu, Shen Du & Jifeng Jiang

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Xing, F., Zhang, T., Miao, X. et al. Long-term evolution of LR-2, LR-3 and LR-4 observations in HBV-related cirrhosis based on LI-RADS v2018 using gadoxetic acid-enhanced MRI. Abdom Radiol 48, 3703–3713 (2023). https://doi.org/10.1007/s00261-023-04016-7

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