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Ancillary features in the Liver Imaging Reporting and Data System: how to improve diagnosis of hepatocellular carcinoma ≤ 3 cm on magnetic resonance imaging

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To determine the strength of association with hepatocellular carcinoma (HCC) of each ancillary feature (AF) in LI-RADS version 2018, and to develop an appropriate strategy for applying AFs to improve the diagnosis of HCC ≤ 3 cm on gadoxetate-enhanced MRI.

Methods

A total of 385 nodules (283 HCCs, 18 non-HCC malignancies, 84 benign nodules) of ≤ 3 cm in 266 patients at risk for HCC who underwent gadoxetate-enhanced MRI in 2016 were retrospectively evaluated. Two radiologists independently evaluated the presence/absence of AFs, and assigned a LI-RADS category to each nodule. Diagnostic odds ratio (DOR) of each AF was assessed. To improve the diagnostic performance for HCC, various criteria were developed based on the number of AFs favoring malignancy in general or HCC in particular. Generalized estimating equation models were used to compare the diagnostic performance of each criterion with that of the major features (MFs) only.

Result

All AFs favoring HCC in particular and malignancy in general were more common in the HCC group than in the non-HCC group. Of these AFs, hepatobiliary-phase hypointensity had the strongest association with HCC (DOR, 21.82; 95% confidence interval, 5.59–85.20). When we applied AFs in addition to MFs, the new criterion (with a number of AFs ≥ 4) had significantly higher sensitivity (80.6% vs. 70.0%; p < 0.001) than MFs only, without significant lower specificity (85.3% vs. 90.2%; p = 0.060).

Conclusions

The AFs varied in the strengths of association with HCC. More strict application of AFs (AFs ≥ 4) in LR-3 may improve the diagnostic performance for probable HCC ≤ 3 cm.

Key Points

• The ancillary features (AFs) in the Liver Imaging Reporting and Data System version 2018 showed variable frequencies of occurrence and strengths of association with hepatocellular carcinoma (HCC).

• Of the various AFs, hepatobiliary-phase hypointensity had the highest frequency and strongest association with HCC on gadoxetate disodium–enhanced MRI.

• When applying AFs in addition to major features, a criterion of four or more AFs significantly increased the sensitivity for diagnosing HCC, without a significantly decreased specificity, especially in LR-3 observations.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AF:

Ancillary feature

DOR:

Diagnostic odds ratio

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MF:

Major feature

MRI:

Magnetic resonance imaging

RFA:

Radiofrequency ablation

TACE:

Transcatheter arterial chemoembolization

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Funding

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

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Author notes

  1. Ji Hun Kang and Sang Hyun Choi contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Ji Hun Kang, Sang Hyun Choi, Jae Ho Byun, Dong Hwan Kim, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin & Pyo-Nyun Kim

  2. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong Hwan Kim

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  1. Ji Hun Kang
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Corresponding author

Correspondence to Jae Ho Byun.

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Guarantor

The scientific guarantor of this publication is Jae Ho Byun.

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

No complex statistical methods were necessary for this paper

Informed consent

Written informed consent was waived by the Institutional Review Board because of the retrospective nature of the study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

There was subject overlap with an original article in J Hepatol (doi: https://doi.org/10.1016/j.jhep.2019.05.005) entitled “Arterial Subtraction Images of Gadoxetate-Enhanced MRI Improve Diagnosis of Early-Stage Hepatocellular Carcinoma”.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Kang, J.H., Choi, S.H., Byun, J.H. et al. Ancillary features in the Liver Imaging Reporting and Data System: how to improve diagnosis of hepatocellular carcinoma ≤ 3 cm on magnetic resonance imaging. Eur Radiol 30, 2881–2889 (2020). https://doi.org/10.1007/s00330-019-06645-3

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  • DOI: https://doi.org/10.1007/s00330-019-06645-3

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