From the Department of Radiology and Research Institute of Radiology (S.H.C., S.S.L., Y.M.S., M.G.L.), Department of Gastroenterology (K.M.K.), and Department of Pathology (E.Y., Y.P.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; and Department of Radiology, Gil Medical Center, Gachon University, Incheon, South Korea (S.H.P.).
Radiology. 2019 Feb;290(2):388-397. doi: 10.1148/radiol.2018181290. Epub 2018 Nov 13.
Purpose To (a) evaluate the postsurgical prognostic implication of the Liver Imaging Reporting and Data System (LI-RADS) categories of primary liver cancers and (b) determine the performance of LI-RADS version 2017 in differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (IHCC) and combined hepatocellular-cholangiocarcinoma (cHCC-CC) at gadoxetic acid-enhanced MRI. Materials and Methods In this retrospective study, 194 patients with cirrhosis and surgically proven single primary liver cancer (53 with cHCC-CC, 44 with IHCC, and 97 with HCC) were evaluated with gadoxetic acid-enhanced MRI between 2009 and 2014. The mean patient age was 57 years (age range, 30-83 years). There were 155 men with a mean age of 56 years (range, 30-81 years) and 39 women with a mean age of 58 years (range, 38-83 years). Two independent readers assigned an LI-RADS category for each nodule. Overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated by using the Kaplan-Meier method, log-rank test, and Cox proportional hazard model. Results In the multivariable analysis, the LI-RADS category was an independent factor for OS (hazard ratio, 4.2; P < .001) and RFS (hazard ratio, 2.6; P = .01). The LR-M category showed more correlation with poorer OS and RFS than did the LR-4 or LR-5 category for all primary liver cancers (P < .001 for both), HCCs (P = .01 and P < .001, respectively), and cHCC-CCs (P = .01 and P = .03, respectively). The LR-5 category had a sensitivity of 69% (67 of 97) and a specificity of 87% (84 of 97) in the diagnosis of HCC; most false-positive diagnoses (85%, 11 of 13) were the result of misclassification of cHCC-CCs. Conclusion The Liver Imaging Reporting and Data System (LI-RADS) category was associated with postsurgical prognosis of primary liver cancers, independent of pathologic diagnosis. The LI-RADS enabled the correct classification of most hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinomas, whereas differentiation of combined hepatocellular-cholangiocarcinoma from HCC was unreliable. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Bashir and Chernyak in this issue.
(a) 评估肝脏成像报告和数据系统（LI-RADS）对原发性肝癌的术后预后的影响；(b) 确定 LI-RADS 版本 2017 在区分肝细胞癌（HCC）、肝内胆管细胞癌（IHCC）和混合型肝细胞癌-胆管细胞癌（cHCC-CC）方面在钆塞酸增强 MRI 中的表现。
本回顾性研究纳入了 194 例肝硬化合并经手术证实的单发原发性肝癌患者（53 例为 cHCC-CC，44 例为 IHCC，97 例为 HCC），这些患者于 2009 年至 2014 年期间接受了钆塞酸增强 MRI 检查。患者的平均年龄为 57 岁（年龄范围：30-83 岁）。其中 155 例为男性，平均年龄为 56 岁（年龄范围：30-81 岁），39 例为女性，平均年龄为 58 岁（年龄范围：38-83 岁）。两位独立的读者为每个结节分配了一个 LI-RADS 类别。采用 Kaplan-Meier 方法、对数秩检验和 Cox 比例风险模型评估总生存（OS）、无复发生存（RFS）及其相关因素。
在多变量分析中，LI-RADS 类别是 OS（危险比，4.2；P＜.001）和 RFS（危险比，2.6；P =.01）的独立影响因素。与 LR-4 或 LR-5 类别相比，LR-M 类别与所有原发性肝癌（均 P＜.001）、HCC（P=.01 和 P＜.001）和 cHCC-CC（P=.01 和 P=.03）的 OS 和 RFS 相关性更差。LR-5 类别在诊断 HCC 时的敏感性为 69%（97 例中 67 例），特异性为 87%（97 例中 84 例）；大多数假阳性诊断（85%，11/13）是由于 cHCC-CC 的错误分类。
LI-RADS 类别与原发性肝癌的术后预后相关，独立于病理诊断。LI-RADS 可正确分类大多数 HCC 和 IHCC，但区分 cHCC-CC 与 HCC 不可靠。
Zotero 插件