From the Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea (S.M.L.); Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.L., S.J.A., H.J.K., H.K.Y., J.H.Y.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (J.M.L., J.H.Y.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.); and Department of Medical Imaging, Saint Michael's Hospital, University of Toronto, Toronto, ON, Canada (H.K.Y.).
Radiology. 2019 Sep;292(3):655-663. doi: 10.1148/radiol.2019182867. Epub 2019 Jul 16.
Background Few studies have reported on the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) LR-5 or LR-5 V in the diagnosis of hepatocellular carcinoma (HCC) using MRI with gadoxetate disodium. Purpose To determine the diagnostic performance of LI-RADS version 2018 (hereafter, v2018) on gadoxetate disodium-enhanced MRI in comparison with LI-RADS version 2017 (hereafter, v2017) for the diagnosis of HCC in patients with cirrhosis or chronic hepatitis B viral infection or at high risk for HCC. Materials and Methods This retrospective study between January 2013 and October 2015 evaluated consecutive patients at high risk for HCC who had at least one observation of 10 mm or greater on gadoxetate disodium-enhanced MRI and no history of previous treatment for hepatic lesions. MRI features were reviewed by three radiologists. Observations were categorized according to LI-RADS v2018 and LI-RADS v2017. Per-observation sensitivity and specificity of LR-5 using LI-RADS v2017 and v2018 were compared using generalized estimating equation models. Results A total of 422 observations, including 234 HCCs confirmed by results of pathologic examination in 387 patients (305 men and 82 women; mean age ± standard deviation, 59 years ± 10), were included. In all observations, LI-RADS v2018 provided higher sensitivity than LI-RADS v2017 (81% [189 of 234] vs 68% [160 of 234], respectively; < .001). In small observations (10-19 mm), LI-RADS v2018 yielded much higher sensitivity than LI-RADS v2017 (76% [34 of 45] vs 11% [five of 45], respectively; < .001) with relatively little impairment of specificity (94% [121 of 128] vs 99% [127 of 128], respectively; = .013). Conclusion Updated LR-5 criteria of Liver Imaging Reporting and Data System (LI-RADS) version 2018 on gadoxetate disodium-enhanced MRI can improve sensitivity in the diagnosis of small hepatocellular carcinomas (10-19 mm) with only slight impairment in specificity compared with the criteria of LI-RADS version 2017. © RSNA, 2019
背景 ：在使用钆塞酸二钠增强 MRI 检查的情况下，鲜有研究报告过 Liver Imaging Reporting and Data System (LI-RADS) LR-5 或 LR-5 V 对肝细胞癌 (HCC)的诊断性能。目的 ：旨在确定 LI-RADS 2018 版（以下简称 v2018）在诊断肝硬化或慢性乙型肝炎病毒感染或 HCC 高危患者的 HCC 方面的表现，与 LI-RADS 2017 版（以下简称 v2017）相比。材料与方法 ：本回顾性研究于 2013 年 1 月至 2015 年 10 月期间，纳入了至少有一次在钆塞酸二钠增强 MRI 上观察到 10mm 或更大的 HCC 高危患者，且无肝病变既往治疗史。由三位放射科医生对 MRI 特征进行了回顾性分析。根据 LI-RADS v2018 和 LI-RADS v2017 对观察结果进行分类。使用广义估计方程模型比较了使用 LI-RADS v2017 和 v2018 的 LR-5 的每个观察的敏感性和特异性。结果 ：共纳入了 422 个观察结果，其中包括 387 例患者（305 例男性，82 例女性；平均年龄±标准差，59 岁±10 岁）中经病理检查证实的 234 例 HCC。在所有观察中，LI-RADS v2018 的敏感性均高于 LI-RADS v2017（81%[234 例中的 189 例]与 68%[234 例中的 160 例]；<.001）。在小观察（10-19mm）中，LI-RADS v2018 的敏感性明显高于 LI-RADS v2017（76%[45 例中的 34 例]与 11%[45 例中的 5 例]；<.001），特异性仅略有下降（94%[128 例中的 121 例]与 99%[128 例中的 127 例]；=.013）。结论 ：与 LI-RADS v2017 相比，在使用钆塞酸二钠增强 MRI 时，更新后的 Liver Imaging Reporting and Data System (LI-RADS) v2018 的 LR-5 标准可以提高对小 HCC（10-19mm）的诊断敏感性，而特异性仅有微小的降低。
