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Prognostic value of LI-RADS category on gadoxetic acid–enhanced MRI and 18F-FDG PET-CT in patients with primary liver carcinomas

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To evaluate the postoperative prognostic value of the Liver Imaging Reporting and Data System (LI-RADS) category on gadoxetic acid–enhanced MRI and 18F-fluorodeoxyglucose PET-CT in patients with primary liver carcinomas (PLCs).

Methods

A total of 189 patients with chronic liver disease and surgically proven single PLC (42 intrahepatic cholangiocarcinomas and 21 combined hepatocellular-cholangiocarcinomas and 126 hepatocellular carcinomas [2:1 matching to non-HCC malignancies]) were retrospectively evaluated with gadoxetic acid–enhanced MRI and PET-CT. Two independent reviewers assigned an LI-RADS category for each observation. The tumor-to-liver standardized uptake value ratio (TLR) was calculated. The overall survival (OS), recurrence-free survival (RFS), and the associated factors were evaluated.

Results

In multivariable analysis, LI-RADS category (LR-4 or LR-5 [LR-4/5] vs. LR-M; OS, hazard ratio [HR] 2.24, p = 0.006; RFS, HR 1.61, p = 0.028) and TLR (low, < 2.3 vs. high, ≥ 2.3; OS, HR 2.09, p = 0.014; RFS, HR 2.17, p < 0.001) were the independent factors for OS and RFS. For the LR-M group, the high TLR group showed lower OS and RFS rates than the low TLR group (OS, p = 0.008; RFS, p < 0.001). For the LR-4/5 group, the OS and RFS rates were not significantly different between the high TLR and low TLR groups (both p > 0.05).

Conclusions

Both LI-RADS category on MRI and TLR on PET-CT are associated with the postoperative prognosis of PLCs. The prognosis of PLCs classified as LR-M can be further stratified according to the TLR group, but not for the PLCs classified as LR-4/5.

Key Points

• The LI-RADS category (LR-4/5 vs. LR-M) and tumor-to-liver standardized uptake value ratio (TLR, low vs. high) were independent factors for postoperative prognosis of primary liver carcinomas (PLCs).

• For PLCs classified as LR-M, the TLR group helps stratify the postoperative prognosis of PLCs, with the high TLR group having a poor prognosis and the low TLR group having a better prognosis (p = 0.008 for OS and p < 0.001 for RFS).

• For PLCs classified as LR-4/5, the OS and RFS rates were not significantly different between the high TLR and low TLR groups (both p > 0.05).

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Abbreviations

cHCC-CC:

Combined hepatocellular-cholangiocarcinoma

CI:

Confidence interval

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

ICC:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MVI:

Microvascular invasion

OS:

Overall survival

PLC:

Primary liver carcinoma

RFS:

Recurrence-free survival

TLR:

Tumor-to-liver standardized uptake value ratio

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Funding

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

Author information

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Republic of Korea

    Ji Hye Min, Seong Hyun Kim & Jeong Ah Hwang

  2. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Seung Hyup Hyun

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sang Yun Ha

  4. Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

    Seo-Youn Choi

  5. Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul, Republic of Korea

    Seon Woo Kim & Hye Seung Kim

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  1. Ji Hye Min
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Corresponding author

Correspondence to Seong Hyun Kim.

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Guarantor

The scientific guarantor of this publication is Seong Hyun Kim (kshyun@skku.edu).

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

Two authors (Seon Woo Kim and Hye Seung Kim) have significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (IRB 2020-04-018).

Study subjects or cohorts overlap

Parts of the study samples were included in the prior report from our institution (Min et al Radiology 2019;290(3):691–699, Lee et al Radiology 2016 Oct;281(1):119–28, and Lim et al Eur J Nucl Med Mol Imaging 2019;46(8):1705-1712). Among the 63 patients with non-HCC (42 intrahepatic cholangiocarcinomas [ICC] and 21 combined hepatocellular-cholangiocarcinomas [cHCC-CC]), imaging findings of 23 (54.8%) ICCs and 12 (57.1%) combined cHCC-CCs have been previously reported. Previous studies focused on the imaging–pathology correlation and prognosis of ICCs using MRI (Min et al and Lee et al) or prognosis of cHCC-CCs using FDG PET-CT (Lim et al). Our current study evaluated the postoperative prognostic role of LI-RADS and PET-CT for ICCs and cHCC-CCs.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Min, J.H., Kim, S.H., Hwang, J.A. et al. Prognostic value of LI-RADS category on gadoxetic acid–enhanced MRI and 18F-FDG PET-CT in patients with primary liver carcinomas. Eur Radiol 31, 3649–3660 (2021). https://doi.org/10.1007/s00330-020-07378-4

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