Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, UOC di Radiologia, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2019 Sep;23(18):7786-7801. doi: 10.26355/eurrev_201909_18988.
To evaluate the performance of major features, ancillary features, and categories of Liver Imaging Reporting and Data System (LI-RADS) version 2018 at magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) from dysplastic nodules (DNs).
This retrospective study included cirrhotic patients with pathologically proven untreated HCCs and DNs (≤ 2 cm) and liver MR imaging performed with gadobenate dimeglumine contrast agent within 3 months before pathological analysis, between 2015 and 2018. 37 patients with 43 observations (17 HCCs and 26 DNs) met the inclusion criteria. Two radiologists assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS v2018 category in consensus. Estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed based on their sensitivity, specificity, positive (PPV), and negative predictive values (NPV).
Major features (nonrim arterial phase hyperenhancement, nonperipheral "washout", and enhancing "capsule") had a sensitivity of 94.1%, 88.2%, and 41.2%, and a specificity of 57.7%, 42.3%, and 88.5% for HCC, respectively. Ancillary features (hepatobiliary phase hypointensity, mild-moderate T2 hyperintensity, restricted diffusion, and fat in the lesion more than adjacent liver) had a sensitivity of 94.1%, 64.7%, 58.8%, and 11.8%, and a specificity of 26.9%, 61.5%, 65.4%, and 76.9% for HCC, respectively. The LR-5 category (determined by using major features only vs. the combination of major and ancillary features) had a sensitivity of 88.2% at both evaluations and a specificity of 76.9% and 80.8% for HCC, respectively. The combination of LR-4, LR-5 categories (determined by using major features only vs. the combination of major and ancillary features) had a sensitivity of 94.1% at both interpretations and a specificity of 65.4% and 26.9% for HCC, respectively. The use of ancillary features modified LI-RADS category in 25.6% of observations (11/43), predominantly upgraded from LR-3 to LR4 (10/11), increasing the proportion of low-grade DNs and high-grade DNs categorized as LR-4 (from 15.4% to 61.5% and from 7.7% to 46.1%, respectively).
The added value of ancillary features in combination with major features is limited for the non-invasive diagnosis of small HCC; however, their use modifies the final category in a substantial proportion of observations from LR-3 to LR-4, thus allowing possible changes in the management of patients at risk for HCC.
评估主要特征、辅助特征和肝脏成像报告和数据系统（LI-RADS）版本 2018 分类在磁共振成像（MR 成像）中小肝细胞癌（HCC）与发育不良结节（DNs）的鉴别诊断中的性能。
这项回顾性研究纳入了经病理证实未治疗的 HCC 和 DNs（≤2cm）的肝硬化患者，这些患者在病理分析前 3 个月内接受了钆贝葡胺造影剂的肝脏 MR 成像，时间在 2015 年至 2018 年之间。37 名患者的 43 个观察结果（17 个 HCC 和 26 个 DNs）符合纳入标准。两名放射科医生对每个肝脏观察的主要和辅助成像特征进行评估，并在共识基础上分配 LI-RADS v2018 类别。根据主要特征、辅助特征和 LI-RADS 类别的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）评估其诊断性能。
主要特征（非环形动脉期高增强、非外周“洗脱”和增强“包膜”）对 HCC 的敏感性分别为 94.1%、88.2%和 41.2%，特异性分别为 57.7%、42.3%和 88.5%。辅助特征（肝胆期低信号、轻度至中度 T2 高信号、限制扩散和病变内脂肪多于相邻肝脏）对 HCC 的敏感性分别为 94.1%、64.7%、58.8%和 11.8%，特异性分别为 26.9%、61.5%、65.4%和 76.9%。LR-5 类别（仅使用主要特征与主要特征和辅助特征的组合确定）在两次评估中的敏感性均为 88.2%，特异性分别为 76.9%和 80.8%。LR-4、LR-5 类别（仅使用主要特征与主要特征和辅助特征的组合确定）的组合在两次解释中的敏感性均为 94.1%，特异性分别为 65.4%和 26.9%。辅助特征的使用在 25.6%（11/43）的观察中改变了 LI-RADS 类别，主要是从 LR-3 升级为 LR-4（10/11），增加了低级别 DNs 和高级别 DNs 被归类为 LR-4 的比例（从 15.4%到 61.5%和从 7.7%到 46.1%）。
辅助特征与主要特征结合在 HCC 的非侵入性诊断中增值有限；然而，它们的使用在很大比例的观察中从 LR-3 改变为 LR-4，从而允许对 HCC 风险患者的管理进行可能的改变。
