From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Radiology. 2018 Jan;286(1):158-172. doi: 10.1148/radiol.2017170114. Epub 2017 Aug 29.
Purpose To evaluate the diagnostic performance and interrater reliability of the Liver Imaging Reporting and Data System (LI-RADS) version 2014 in differentiating hepatocellular carcinoma (HCC) from non-HCC malignancy in a population of patients at risk for HCC. Materials and Methods This retrospective HIPAA-compliant institutional review board-approved study was exempt from informed consent. A total of 178 pathology-proven malignant liver masses were identified in 178 patients at risk for HCC but without established extrahepatic malignancy from August 2012 through August 2015. Two readers blinded to pathology findings and clinical follow-up data independently evaluated a liver protocol magnetic resonance or computed tomography study for each lesion and assigned LI-RADS categories, scoring all major and most ancillary features. Statistical analyses included the independent samples t test, x test, Fisher exact test, and Cohen k. Results This study included 136 HCCs and 42 non-HCC malignancies. Specificity and positive predictive value of an HCC imaging diagnosis (LR-5 or LR-5V) were 69.0% and 90.5%, respectively, for reader 1 (R1) and 88.3% and 95.5%, respectively, for reader 2 (R2). Tumor in vein was a common finding in patients with non-HCC malignancies (R1, 10 of 42 [23.8%]; R2, five of 42 [11.9%]). Exclusion of the LR-5V pathway improved specificity and positive predictive value for HCC to 83.3% and 92.9%, respectively, for R1 (six fewer false-positive findings) and 92.3% and 96.4%, respectively, for R2 (one fewer false-positive finding). Among masses with arterial phase hyperenhancement, the rim pattern was more common among non-HCC malignancies than among HCCs for both readers (R1: 24 of 36 [66.7%] vs 13 of 124, [10.5%], P < .001; R2: 27 of 35 [77.1%] vs 21 of 123 [17.1%], P < .001) (k = 0.76). Exclusion of rim arterial phase hyperenhancement as a means of satisfying LR-5 criteria also improved specificity and positive predictive value for HCC (R1, two fewer false-positive findings). Conclusion Modification of the algorithmic role of tumor in vein and rim arterial phase hyperenhancement improves the diagnostic performance of LI-RADS version 2014 in differentiating HCC from non-HCC malignancy. RSNA, 2017 Online supplemental material is available for this article.
目的 旨在评估肝脏影像报告和数据系统（LI-RADS）第 2014 版在区分 HCC 与非 HCC 恶性肿瘤方面的诊断性能和观察者间可靠性，该研究人群为 HCC 高危患者。
材料与方法 本回顾性 HIPAA 合规性机构审查委员会批准的研究无需知情同意。在 2012 年 8 月至 2015 年 8 月期间，我们在 178 例 HCC 高危患者中确定了 178 例经病理证实的恶性肝脏肿块，这些患者无明确的肝外恶性肿瘤病史。两名观察者对每位患者的肝脏协议磁共振或计算机断层扫描研究进行盲法评估，并根据病理发现和临床随访数据独立分配 LI-RADS 类别，对所有主要和大多数辅助特征进行评分。统计分析包括独立样本 t 检验、x 检验、Fisher 确切检验和 Cohen k。
结果 本研究包括 136 例 HCC 和 42 例非 HCC 恶性肿瘤。对于观察者 1（R1），HCC 影像学诊断（LR-5 或 LR-5V）的特异性和阳性预测值分别为 69.0%和 90.5%，对于观察者 2（R2），特异性和阳性预测值分别为 88.3%和 95.5%。在非 HCC 恶性肿瘤患者中，肿瘤侵犯静脉是一种常见的表现（R1，42 例中有 10 例[23.8%]；R2，42 例中有 5 例[11.9%]）。排除 LR-5V 途径可将 HCC 的特异性和阳性预测值分别提高至 83.3%和 92.9%（R1 减少了 6 例假阳性发现）和 92.3%和 96.4%（R2 减少了 1 例假阳性发现）。在具有动脉期强化的肿块中，对于两位观察者，边缘增强模式在非 HCC 恶性肿瘤中比 HCC 中更常见（R1：36 例中有 24 例[66.7%]比 124 例中有 13 例[10.5%]，P <.001；R2：35 例中有 27 例[77.1%]比 123 例中有 21 例[17.1%]，P <.001）（k = 0.76）。排除边缘动脉期强化作为满足 LR-5 标准的一种方法也可提高 HCC 的诊断性能（R1，减少了 2 例假阳性发现）。
结论 对肿瘤侵犯静脉和边缘动脉期强化在算法中的作用进行修改可提高 LI-RADS 第 2014 版在区分 HCC 与非 HCC 恶性肿瘤方面的诊断性能。
