Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016.
AJR Am J Roentgenol. 2020 Aug;215(2):382-389. doi: 10.2214/AJR.19.22033. Epub 2020 May 20.
The purposes of this study were to evaluate the outcome of new arterial phase enhancing nodules at MRI of cirrhotic livers, including clinical and imaging factors that affect progression to hepatocellular carcinoma (HCC), and to assess the diagnostic performance of Liver Imaging Reporting and Data System version 2018 (LI-RADSv2018) versus version 2017 (LI-RADSv2017) in categorizing these nodules. A database search identified 129 new arterial phase enhancing, round, solid, space-occupying nodules in 79 patients with cirrhosis who underwent surveillance MRI. Three readers assessed the nodules for LI-RADS findings and made assessments based on the 2017 and 2018 criteria. Clinical information and laboratory values were collected. Outcome data were assessed on the basis of follow-up imaging and pathology results. Interreader agreement was assessed. Logistic regression and ROC curve analyses were used to assess the utility of the features for prediction of progression to HCC. Of the 129 nodules, 71 (55%) progressed to HCC. LI-RADSv2017 score, LIRADSv2018 score, and mild-to-moderate T2 hyperintensity were significant independent predictors of progression to HCC in univariate analyses. Serum α-fetoprotein level, hepatitis B or C virus infection as the cause of liver disease, and presence of other HCCs were significant predictors of progression to HCC in multivariate analyses. The rates of progression of LI-RADS category 3 and 4 observations were 38.1% and 57.6%, respectively, for LI-RADSv2017 and 44.4% and 69.9%, respectively, for LI-RADSv2018. New arterial phase enhancing nodules in patients with cirrhosis frequently progress to HCC. Factors such as serum α-fetoprotein level and presence of other HCCs are strong predictors of progression to HCC.
本研究旨在评估肝硬化患者 MRI 中新动脉期强化结节的结果，包括影响肝细胞癌（HCC）进展的临床和影像学因素，并评估 Liver Imaging Reporting and Data System 版本 2018（LI-RADSv2018）与版本 2017（LI-RADSv2017）在对这些结节进行分类时的诊断性能。通过数据库检索，在 79 例接受监测 MRI 的肝硬化患者中发现了 129 个新的动脉期强化、圆形、实性、占位性结节。三位读者评估了 LI-RADS 发现，并根据 2017 年和 2018 年的标准进行了评估。收集了临床信息和实验室值。根据随访影像学和病理学结果评估结果数据。评估了读者间的一致性。使用逻辑回归和 ROC 曲线分析评估了这些特征预测 HCC 进展的效用。在 129 个结节中，71 个（55%）进展为 HCC。LI-RADSv2017 评分、LIRADSv2018 评分和轻度至中度 T2 高信号是单因素分析中 HCC 进展的独立显著预测因素。血清甲胎蛋白水平、乙型或丙型肝炎病毒感染作为肝病的原因以及存在其他 HCC 是多因素分析中 HCC 进展的显著预测因素。LI-RADSv2017 观察的 3 级和 4 级观察的进展率分别为 38.1%和 57.6%，LI-RADSv2018 分别为 44.4%和 69.9%。肝硬化患者的新动脉期强化结节常进展为 HCC。血清甲胎蛋白水平和存在其他 HCC 等因素是 HCC 进展的强烈预测因素。
