Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Eur Radiol. 2020 May;30(5):2881-2889. doi: 10.1007/s00330-019-06645-3. Epub 2020 Feb 4.
To determine the strength of association with hepatocellular carcinoma (HCC) of each ancillary feature (AF) in LI-RADS version 2018, and to develop an appropriate strategy for applying AFs to improve the diagnosis of HCC ≤ 3 cm on gadoxetate-enhanced MRI.
A total of 385 nodules (283 HCCs, 18 non-HCC malignancies, 84 benign nodules) of ≤ 3 cm in 266 patients at risk for HCC who underwent gadoxetate-enhanced MRI in 2016 were retrospectively evaluated. Two radiologists independently evaluated the presence/absence of AFs, and assigned a LI-RADS category to each nodule. Diagnostic odds ratio (DOR) of each AF was assessed. To improve the diagnostic performance for HCC, various criteria were developed based on the number of AFs favoring malignancy in general or HCC in particular. Generalized estimating equation models were used to compare the diagnostic performance of each criterion with that of the major features (MFs) only.
All AFs favoring HCC in particular and malignancy in general were more common in the HCC group than in the non-HCC group. Of these AFs, hepatobiliary-phase hypointensity had the strongest association with HCC (DOR, 21.82; 95% confidence interval, 5.59-85.20). When we applied AFs in addition to MFs, the new criterion (with a number of AFs ≥ 4) had significantly higher sensitivity (80.6% vs. 70.0%; p < 0.001) than MFs only, without significant lower specificity (85.3% vs. 90.2%; p = 0.060).
The AFs varied in the strengths of association with HCC. More strict application of AFs (AFs ≥ 4) in LR-3 may improve the diagnostic performance for probable HCC ≤ 3 cm.
• The ancillary features (AFs) in the Liver Imaging Reporting and Data System version 2018 showed variable frequencies of occurrence and strengths of association with hepatocellular carcinoma (HCC). • Of the various AFs, hepatobiliary-phase hypointensity had the highest frequency and strongest association with HCC on gadoxetate disodium-enhanced MRI. • When applying AFs in addition to major features, a criterion of four or more AFs significantly increased the sensitivity for diagnosing HCC, without a significantly decreased specificity, especially in LR-3 observations.
确定 LI-RADS 版本 2018 中每个辅助特征（AF）与肝细胞癌（HCC）的关联强度，并制定应用 AF 的适当策略，以提高对钆塞酸二钠增强 MRI 上≤3cm HCC 的诊断准确性。
回顾性分析 2016 年 266 例 HCC 高危患者共 385 个≤3cm 结节（283 个 HCC、18 个非 HCC 恶性肿瘤、84 个良性结节）的资料。两名放射科医生独立评估了 AFs 的存在/缺失情况，并为每个结节分配了 LI-RADS 类别。评估了每个 AF 的诊断优势比（DOR）。为了提高 HCC 的诊断性能，根据普遍或特别有利于恶性肿瘤的 AF 数量制定了各种标准。使用广义估计方程模型比较了每个标准与仅主要特征（MFs）的诊断性能。
在 HCC 组中，所有特别有利于 HCC 和普遍有利于恶性肿瘤的 AFs 比非 HCC 组更常见。在这些 AFs 中，肝胆期低信号与 HCC 的关联最强（DOR，21.82；95%置信区间，5.59-85.20）。当我们将 MFs 与 AFs 联合应用时，新的标准（≥4 个 AFs）的敏感性明显更高（80.6%比 70.0%；p<0.001），而特异性无明显降低（85.3%比 90.2%；p=0.060）。
AFs 与 HCC 的关联强度不同。在 LR-3 中更严格地应用 AFs（≥4 个）可能会提高对≤3cm 可能性 HCC 的诊断性能。
