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Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The LI-RADS M (LR-M) category describes hepatic lesions probably or definitely malignant, but not specific for hepatocellular carcinoma in at-risk patients. Differentiation among LR-M entities, particularly detecting cholangiocarcinoma-containing tumors (M-CCs), is essential for treatment and prognosis. Thus, we aimed to develop diagnostic models on gadoxetate disodium–enhanced MRI comprising serum tumor markers and LI-RADS imaging features for M-CC.

Methods

Consecutive at-risk patients with LR-M lesions exclusively (no co-existing LR-4 and/or LR-5 lesions) were retrieved retrospectively from a prospectively collected database spanning 3 years. Intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (c-HCC-CCA) were classified together as M-CC. LI-RADS features determined by three independent radiologists and clinically relevant serum tumor markers were used to generate M-CC diagnostic models through logistic regression analysis against histology. Per-patient performance was evaluated using area under the receiver operating curve (AUC), sensitivity, and specificity.

Results

Forty-five patients were included, 42.2% (19/45) with hepatocellular carcinoma, 33.3% (15/45) with ICC, 13.3% (6/45) with c-HCC-CCA, and 11.1% (5/45) with other hepatic lesions. Carbohydrate antigen (CA)19-9 > 38 U/mL, α-fetoprotein (AFP) > 4.8 ng/mL, and absence of the LI-RADS feature “blood products in mass” were significant predictors of M-CC. Combining three predictors demonstrated AUC of 0.862, sensitivity of 76%, and specificity of 88%. The risk of M-CC with all three criteria fulfilled was 98% (AUC, 0.690; sensitivity, 38%; specificity, 100%).

Conclusions

In at-risk patients with LR-M lesions, integrating CA19-9, AFP, and the LI-RADS feature “blood products in mass” achieved high diagnostic performance for M-CC. When all three criteria were fulfilled, the specificity for M-CC was 100%.

Key Points

• In at-risk patients who had LR-M lesions exclusively (no concomitant LR-4/5 lesions), a model with carbohydrate antigen > 38 U/mL, α-fetoprotein > 4.8 ng/mL, and absence of the LI-RADS feature “blood products in mass” achieved high accuracy for diagnosing cholangiocarcinoma-containing tumors.

• In patients of whom all three criteria were fulfilled, the specificity for M-CC was 100%, which might reduce or eliminate the need for biopsy confirmation.

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Abbreviations

AFP:

α-Fetoprotein

CA:

Carbohydrate antigen

c-HCC-CCA:

Combined hepatocellular-cholangiocarcinoma

EOB-MRI:

Gadoxetate disodium–enhanced magnetic resonance imaging

ICC:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver Imaging Reporting and Data System

M-CC:

Cholangiocarcinoma-containing tumors

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Funding

This study has received funding by Research Grant of National Natural Science Foundation of China (No. 81771797).

Author information

Author notes

  1. Hanyu Jiang and Bin Song contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Hanyu Jiang, Bin Song, Yun Qin, Jie Chen & Xijiao Liu

  2. Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA

    Hanyu Jiang, Hong II Ha & Mustafa R. Bashir

  3. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA

    Dong Xiao & Alaattin Erkanli

  4. Department of Medicine (Gastroenterology), Duke University Medical Center, Durham, NC, 27710, USA

    Omobonike Oloruntoba-Sanders, Andrew J. Muir & Mustafa R. Bashir

Authors
  1. Hanyu Jiang
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  2. Bin Song
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Corresponding author

Correspondence to Mustafa R. Bashir.

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Guarantor

The scientific guarantor of this publication is Hanyu Jiang.

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 of the authors, Dong Xiao and Alaattin Erkanli, have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because we retrospectively analyzed data from a prospectively collected cohort (Clinical trial registration No. ChiCTR1900026668).

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

In a previous study (Jiang H, Liu X, Chen J, et al (2019) Man or machine? Prospective comparison of the version 2018 EASL, LI-RADS criteria and a radiomics model to diagnose hepatocellular carcinoma. Cancer Imaging 19(1):84), we reported 30 patients included in the current study. While the previous work evaluated and compared the diagnostic accuracies of EASL v2018, LI-RADS v2018 criteria, and a radiomics model for HCC, the current study focused on the detection of M-CC in LR-M patients using a quite different methodology.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Jiang, H., Song, B., Qin, Y. et al. Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features. Eur Radiol 31, 3638–3648 (2021). https://doi.org/10.1007/s00330-020-07488-z

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  • DOI: https://doi.org/10.1007/s00330-020-07488-z

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