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LI-RADS treatment response categorization on gadoxetic acid-enhanced MRI: diagnostic performance compared to mRECIST and added value of ancillary features

  • Hepatobiliary-Pancreas
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Abstract

Objectives

This study was conducted in order to assess the performance of the Liver Imaging Reporting and Data System (LI-RADS) treatment response (TR) (LR-TR) categorization on gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detecting viable tumors in hepatocellular carcinoma (HCC) treated with locoregional treatment (LRT) and to investigate the added value of ancillary features (AFs) to conventional enhancement-based criteria.

Methods

This retrospective study included 183 patients with Gd-EOB-MRI after LRT for HCC and appropriate reference standards for tumor viability (84 viable and 99 nonviable). Two independent radiologists assigned per-lesion mRECIST and TR categories (TR-nonviable, TR-equivocal, or TR-viable) according to the LR-TR algorithm and modified LR-TR algorithms including mLR-TR(TP) allowing transitional phase (TP) washout and mLR-TR(AF) allowing category adjustment by applying AFs. Diagnostic performances of imaging criteria were compared using the Cochran’s Q test with post hoc analysis.

Results

For detecting viable tumors, LR-TR-viable resulted in sensitivities of 64.5%/39.3% and specificities of 98.0%/98.0% in reviewers 1/2. In comparison to LR-TR-viable, mRECIST-viable, mLR-TR(TP)-viable, and mLR-TR(AF)-viable showed significantly higher sensitivities (92.9%/94.0%, 77.4%/56.6%, and 86.9%/83.3% in reviewers 1/2) (ps < 0.001). The specificity of mRECIST-viable (73.7%/62.6%) was significantly lower than that of LR-TR-viable (ps < 0.001), while those of mLR-TR(TP)-viable and mLR-TR(AF)-viable were greater than 95% (98.0%/96.0% and 97.0%/96.0%), statistically equivalent to LR-TR-viable (ps > 0.05). TR-equivocal was least assigned on mLR-TR(AF) (1.1%/7.7%) than LR-TR (15.8%/32.2%) or mLR-TR(TP) (6.6%/23.5%) in both reviewers.

Conclusion

The LR-TR algorithm on Gd-EOB-MRI provides a specific diagnosis of viable tumor but with limited sensitivity. By applying AFs in the category adjustment, more sensitive and confident diagnosis can be achieved without significant loss of specificity.

Key Points

• The LI-RADS treatment response (LR-TR) algorithm on Gd-EOB-MRI provides a highly specific diagnosis of viable HCC but with limited sensitivity.

• The inferior sensitivity of LR-TR-viable category to that of mRECIST can be improved by applying ancillary features in the category adjustment.

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Abbreviations

AP:

Arterial phase

APHE:

Arterial phase hyperenhancement

DWI:

Diffusion-weighted imaging

Gd-EOB-MRI:

Gadoxetic acid-enhanced magnetic resonance imaging

GRE:

Gradient-echo

HASTE:

Half-Fourier acquisition single-shot turbo spin-echo

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LRT:

Locoregional treatment

LR-TR:

LI-RADS treatment response

MDCT:

Multidetector computed tomography

mRECIST:

Modified response evaluation criteria in solid tumors

MRI:

Magnetic resonance imaging

PVP:

Portal venous phase

RFA:

Radiofrequency ablation

TACE:

Trans-catheter arterial chemoembolization

TP:

Transitional phase

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

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Se Woo Kim, Ijin Joo, Hyo-Cheol Kim, Su Joa Ahn, Hyo-Jin Kang, Sun Kyung Jeon & Jeong Min Lee

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Se Woo Kim, Ijin Joo, Hyo-Cheol Kim, Su Joa Ahn, Hyo-Jin Kang, Sun Kyung Jeon & Jeong Min Lee

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Jeong Min Lee

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Correspondence to Ijin Joo.

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Kim, S.W., Joo, I., Kim, HC. et al. LI-RADS treatment response categorization on gadoxetic acid-enhanced MRI: diagnostic performance compared to mRECIST and added value of ancillary features. Eur Radiol 30, 2861–2870 (2020). https://doi.org/10.1007/s00330-019-06623-9

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