Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea.
Seoul National University College of Medicine, Seoul, South Korea.
Eur Radiol. 2020 Sep;30(9):4762-4771. doi: 10.1007/s00330-020-06881-y. Epub 2020 Apr 25.
To compare diagnostic performances of current guidelines for the diagnosis of HCC in LT candidates using gadoxetic acid-enhanced liver MRI (Gd-EOB-MRI).
Eighty-one patients (119 HCCs and 35 non-HCCs) who underwent preoperative Gd-EOB-MRI and subsequent LT were included. Per-lesion imaging diagnoses of HCCs were made using four different guidelines (American Association for the Study of Liver Disease (AASLD), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines, and patient allocation was determined according to Milan criteria (MC). Comparisons of per-lesion sensitivity, specificity, and accuracy of patient allocation between guidelines were performed using logistic regression with generalized estimating equations.
For diagnosis of HCC, AASLD guideline showed highest specificity (97.4%), followed by EASL and KLCA-NCC guidelines (92.1% and 92.1%, p > 0.99 and = 0.15, respectively, in comparison to AASLD), while the specificity of APASL guideline was significantly lower than that of AASLD guideline (78.9% vs. 97.4%, p = 0.006). APASL and KLCA-NCC guidelines (75.9% and 65.6%) showed significantly higher sensitivities than AASLD/EASL guidelines (34.5% and 38.8%, respectively; all ps < 0.001). For organ allocation, KLCA-NCC guideline showed higher accuracy in selecting unsuitable candidates (with non-HCC malignancies or beyond MC HCCs) than EASL guideline (68.4% vs. 31.8%; p = 0.001).
For the diagnosis of HCCs using Gd-EOB-MRI, AASLD guideline provided the highest specificity, followed by EASL, KLCA-NCC, and APASL guidelines with statistically significant difference with only APASL guideline. KLCA-NCC guideline provided the most accurate selection of unsuitable LT candidates.
• AASLD/LI-RADS showed the highest specificity, followed by EASL and KLCA-NCC guidelines. • APASL and KLCA-NCC guidelines allowed more sensitive diagnoses of HCCs. • KLCA-NCC more accurately classified patients not appropriate transplantation candidates than EASL.
比较钆塞酸增强肝脏 MRI（Gd-EOB-MRI）用于诊断 LT 候选者 HCC 时，当前指南的诊断性能。
共纳入 81 例（119 个 HCC 和 35 个非 HCC）接受术前 Gd-EOB-MRI 检查和随后 LT 的患者。使用四种不同的指南（美国肝病研究协会（AASLD）、欧洲肝病研究协会（EASL）、亚太肝病研究协会（APASL）和韩国肝癌协会-国家癌症中心（KLCA-NCC）指南）对 HCC 进行病变水平的影像学诊断，根据米兰标准（MC）确定患者分配。使用广义估计方程的逻辑回归比较指南之间的病变水平敏感性、特异性和患者分配准确性。
对于 HCC 的诊断，AASLD 指南显示出最高的特异性（97.4%），其次是 EASL 和 KLCA-NCC 指南（92.1%和 92.1%，与 AASLD 相比，p 值均>0.99 和 p 值=0.15），而 APASL 指南的特异性明显低于 AASLD 指南（78.9%比 97.4%，p=0.006）。APASL 和 KLCA-NCC 指南（75.9%和 65.6%）显示出明显高于 AASLD/EASL 指南（34.5%和 38.8%，均 p<0.001）的敏感性。对于器官分配，KLCA-NCC 指南在选择不适合的候选者（患有非 HCC 恶性肿瘤或超出 MC 的 HCC）方面比 EASL 指南具有更高的准确性（68.4%比 31.8%；p=0.001）。
对于使用 Gd-EOB-MRI 诊断 HCC，AASLD 指南提供了最高的特异性，其次是 EASL、KLCA-NCC 和 APASL 指南，仅 APASL 指南具有统计学显著性差异。KLCA-NCC 指南更准确地选择了不适合 LT 的候选者。
• AASLD/LI-RADS 显示出最高的特异性，其次是 EASL 和 KLCA-NCC 指南。• APASL 和 KLCA-NCC 指南允许更敏感地诊断 HCC。• KLCA-NCC 比 EASL 更准确地分类不适合移植候选者。
