Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt.
Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt.
Abdom Radiol (NY). 2019 May;44(5):1773-1784. doi: 10.1007/s00261-018-01887-z.
We investigated the added value of diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) in the categorization of small hepatic observation (≤ 20 mm) detected in patients with chronic liver disease in reference to LI-RADS (liver imaging reporting and data system) classification system.
We prospectively evaluated 165 patients with chronic liver disease with small hepatic observations (≤ 20 mm) which were previously categorized as LI-RADS grade 3-5 on dynamic contrast-enhanced CT (DCE-CT). All patients were submitted to a functional MRI including DCE and DWI. Using LI-RADS v2017, two radiologists independently evaluated the observations and assigned a LI-RADS category to each observation using DCE-MRI alone and combined DCE-MRI and DWI/ADC. In the combined technique, the radiologists assigned a LI-RADS category based on a modified LI-RADS criteria in which restricted diffusion on DWI was considered a major feature of HCC. We evaluated the inter-reader agreement with Kappa statistics and compared the diagnostic performance of the LI-RADS with two imaging techniques by Fisher's exact test using histopathology as the reference standard.
Combined technique in LI-RADS yielded better sensitivities (reader 1, 97% [65/67]; reader 2, 95.5% [64/67]) for HCC diagnosis than DCE-MRI alone (reader 1, 80.6% [54/67], p = 0.005; reader 2, 83.6% [56/67], p = 0.04). The specificities were insignificantly lower in combined technique (reader 1, 88.4% [107/121]; reader 2, 77.7% [94/121]) than in DCE-MRI alone (reader 1, 90.9% [110/121], p = 0.67; reader 2, 79.3% [96/121], p = 0.88). The inter-reader agreement of the LI-RADS scores between combined technique and DCE-MRI was good (κ = 0.765).
The use of DWI/ADC as an additional major criterion, improved the sensitivity of LI-RADS in the diagnosis of HCC while keeping high specificity.
我们研究了扩散加权成像（DWI）/表观扩散系数（ADC）在慢性肝病患者中检测到的小肝观察（≤20mm）分类中的附加价值，该观察在参考 LI-RADS（肝脏成像报告和数据系统）分类系统中被归类为 3-5 级。
我们前瞻性评估了 165 例慢性肝病患者，这些患者的小肝观察（≤20mm）先前在动态对比增强 CT（DCE-CT）上被归类为 LI-RADS 3-5 级。所有患者均接受功能 MRI 检查，包括 DCE 和 DWI。使用 LI-RADS v2017，两位放射科医生独立评估了这些观察结果，并单独使用 DCE-MRI 和 DCE-MRI 联合 DWI/ADC 为每个观察结果分配 LI-RADS 类别。在联合技术中，放射科医生根据改良的 LI-RADS 标准分配 LI-RADS 类别，其中 DWI 上的受限扩散被认为是 HCC 的主要特征。我们使用 Kappa 统计评估了读者间的一致性，并使用 Fisher 精确检验比较了 LI-RADS 与两种成像技术的诊断性能，以组织病理学为参考标准。
LI-RADS 联合技术的 HCC 诊断敏感性（读者 1，97%[65/67]；读者 2，95.5%[64/67]）优于单独使用 DCE-MRI（读者 1，80.6%[54/67]，p=0.005；读者 2，83.6%[56/67]，p=0.04）。联合技术的特异性（读者 1，88.4%[107/121]；读者 2，77.7%[94/121]）略低于单独使用 DCE-MRI（读者 1，90.9%[110/121]，p=0.67；读者 2，79.3%[96/121]，p=0.88）。LI-RADS 评分在联合技术和 DCE-MRI 之间的读者间一致性良好（κ=0.765）。
将 DWI/ADC 作为附加的主要标准，提高了 LI-RADS 在 HCC 诊断中的敏感性，同时保持了较高的特异性。
