Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Korean J Radiol. 2021 Jul;22(7):1066-1076. doi: 10.3348/kjr.2020.0846. Epub 2021 Mar 9.
To evaluate the performance of the 2018 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) Practice Guidelines (hereafter, PG) for the diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI, compared to the Liver Imaging-Reporting and Data System (LI-RADS) version 2018 (hereafter, v2018).
From January 2013 to October 2015, treatment-naïve hepatic lesions (≥ 1 cm) on gadoxetic acid-enhanced MRI in consecutive patients with chronic hepatitis B or cirrhosis were retrospectively evaluated. For each lesion, three radiologists independently analyzed the imaging features and classified the lesions into categories according to the 2018 KLCA-NCC PG and LI-RADS v2018. The imaging features and categories were determined by consensus. Generalized estimating equation (GEE) models were used to compare the per-lesion diagnostic performance of the 2018 KLCA-NCC PG and LI-RADS v2018 using the consensus data.
In total, 422 lesions (234 HCCs, 45 non-HCC malignancies, and 143 benign lesions) from 387 patients (79% male; mean age, 59 years) were included. In all lesions, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity and lower specificity than LR-5 (LI-RADS v2018) (87.2% [204/234] vs. 80.8% [189/234], < 0.001; 86.2% [162/188] vs. 91.0% [171/188], = 0.002). However, in lesions of size ≥ 2 cm, the definite HCC had a higher sensitivity than the LR-5 (86.8% [164/189] vs. 82.0 (155/189), = 0.002) without a reduction in the specificity (80.0% [48/60] vs. 83.3% [50/60], = 0.15). In all lesions, the sensitivity and specificity of the definite/probable HCC (2018 KLCA-NCC PG) and LR-5/4 did not differ significantly (89.7% [210/234] vs. 91.5% [214/234], = 0.204; 83.5% [157/188] vs. 79.3% [149/188], = 0.071).
For the diagnosis of HCC of size ≥ 2 cm, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity than LR-5, without a reduction in specificity. The definite/probable HCC (2018 KLCA-NCC PG) had a similar sensitivity and specificity to that those of the LR-5/4.
评估 2018 年韩国肝癌协会-国家癌症中心（KLCA-NCC）实践指南（以下简称 PG）在使用钆塞酸增强 MRI 诊断肝细胞癌（HCC）方面的性能，与 2018 年肝脏成像报告和数据系统（LI-RADS）版本（以下简称 v2018）相比。
从 2013 年 1 月至 2015 年 10 月，对连续接受慢性乙型肝炎或肝硬化治疗的患者的钆塞酸增强 MRI 上的治疗前肝脏病变（≥1cm）进行回顾性评估。对于每个病变，三位放射科医生独立分析影像学特征，并根据 2018 年 KLCA-NCC PG 和 LI-RADS v2018 对病变进行分类。通过共识确定影像学特征和类别。使用广义估计方程（GEE）模型比较 2018 年 KLCA-NCC PG 和 LI-RADS v2018 对共识数据的每例病变的诊断性能。
共纳入了 387 例患者（79%为男性；平均年龄 59 岁）的 422 个病变（234 个 HCC、45 个非 HCC 恶性肿瘤和 143 个良性病变）。在所有病变中，明确 HCC（2018 KLCA-NCC PG）的敏感性高于 LR-5（LI-RADS v2018）（87.2%[204/234]比 80.8%[189/234]，<0.001；86.2%[162/188]比 91.0%[171/188]，=0.002），特异性较低。然而，在大小≥2cm 的病变中，明确 HCC 的敏感性高于 LR-5（86.8%[164/189]比 82.0%[155/189]，=0.002），特异性无降低（80.0%[48/60]比 83.3%[50/60]，=0.15）。在所有病变中，明确/可能 HCC（2018 KLCA-NCC PG）和 LR-5/4 的敏感性和特异性无显著差异（89.7%[210/234]比 91.5%[214/234]，=0.204；83.5%[157/188]比 79.3%[149/188]，=0.071）。
对于大小≥2cm 的 HCC 诊断，明确 HCC（2018 KLCA-NCC PG）的敏感性高于 LR-5，特异性无降低。明确/可能 HCC（2018 KLCA-NCC PG）的敏感性和特异性与 LR-5/4 相似。
