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Retrospective analysis of current guidelines for hepatocellular carcinoma diagnosis on gadoxetic acid–enhanced MRI in at-risk patients

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate and compare the diagnostic performance of the updated HCC guidelines using gadoxetic acid–enhanced MRI.

Methods

In this study, patients at risk of HCC who underwent gadoxetic acid–enhanced MRI following US/CT surveillance were retrospectively recruited from 3 centers. Three radiologists independently evaluated hepatic nodule imaging features relevant to the diagnostic criteria outlined in each guideline. Per-lesion sensitivity, specificity, and accuracy were compared between guidelines using logistic regression with a generalized estimating equation. Inter-observer agreements on imaging features were determined using Fless κ statistics.

Results

Altogether, 447 nodules (310 HCCs, 20 combined hepatocellular-cholangiocarcinomas, 2 cholangiocarcinomas, and 115 benign entities) measuring 1–3 cm from 386 patients were assessed. The KLCA-NCC and APASL guidelines showed the highest sensitivity (82.3–90.6%, p < .001) and accuracy (83.9–88.6%) among the five guidelines. The OPTN/UNOS guideline showed the highest specificity (94.9–97.1%), followed by the AASLD/LI-RADS, EASL, KLCA-NCC, and APASL guidelines, with significant difference only with the APASL guideline. The diagnostic performance of the updated AASLD/LI-RADS and EASL guidelines and of the KLCA-NCC and APASL guidelines was comparable (p > .05). Inter-observer agreement was substantial to almost perfect (κ = 0.73–0.87).

Conclusions

For the diagnosis of HCC using gadoxetic acid–enhanced MRI, the KLCA-NCC and APASL guidelines showed the highest sensitivity and accuracy. The OPTN/UNOS guideline showed the highest specificity. Acknowledging their relative strengths and weaknesses could help adapt the diagnostic criteria according to the clinical context.

Key Points

• APASL and KLCA-NCC provided significantly the highest sensitivity and accuracy, followed by AASLD/LI-RADS and EASL in an endemic area for hepatitis B.

• OPTN/UNOS showed the highest specificity, followed by AASLD/LI-RADS, EASL, KLCA-NCC, and APASL guidelines, with significant difference only with APASL.

• Broadened definition of arterial hyperenhancement, washout, and the size of the lesion eligible to apply diagnostic criteria may improve the diagnostic performance for HCC in an endemic area for hepatitis B.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

APASL:

Asian Pacific Association for the Study of the Liver

APHE:

Arterial phase hyperenhancement

EASL:

European Association for the Study of the Liver

ECA:

Extracellular contrast agent

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

KLCA-NCC:

Korean Liver Cancer Association-National Cancer Center

LI-RADS:

Liver Imaging Reporting and Data System

OPTN:

Organ Procurement and Transplantation Network

PVP:

Portal venous phase

UNOS:

United Network for Organ Sharing

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Funding

This study was supported by a grant from the National Research Foundation of Korea (2017R1A2B3011475) and the Gachon University research fund of 2017 (GCU-2017-5256).

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Corresponding author

Correspondence to Bohyun Kim.

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Guarantor

The scientific guarantor of this publication is Bohyun Kim.

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Statistics and biometry

Ji Hyun Park, who is one of the authors, performed the statistical analysis. Additional analysis was provided by the Office of Biostatistics, Ajou Research Institute for Innovation Medicine, Ajou University Medical Center, Suwon, Korea.

Informed consent

The requirement for written informed consent was waived by the institutional review board of three institutions.

Ethical approval

Institutional Review Board approval of Asan Medical Center, Gil Medical Center, and Ajou University Hospital was obtained.

Study subjects or cohorts overlap

Of the 386 patients in the current study, 280 patients were included in the two prior studies exploring the application of abbreviated MRI in HCC diagnosis. Prior studies differ considerably from current study in terms of the purpose, design, and statistical analysis.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Multicenter study

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Park, S.H., Shim, Y.S., Kim, B. et al. Retrospective analysis of current guidelines for hepatocellular carcinoma diagnosis on gadoxetic acid–enhanced MRI in at-risk patients. Eur Radiol 31, 4751–4763 (2021). https://doi.org/10.1007/s00330-020-07577-z

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  • DOI: https://doi.org/10.1007/s00330-020-07577-z

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