Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Magn Reson Imaging. 2021 Nov;54(5):1446-1454. doi: 10.1002/jmri.27650. Epub 2021 Apr 23.
According to the Liver Imaging Reporting and Data System (LI-RADS), the LI-RADS category M (LR-M), which are probably or definitely malignant but are not specific for hepatocellular carcinomas (HCCs), does not exclude HCCs. A gap in knowledge remains, including their characteristics and recurrence of HCCs categorized as LR-M.
To compare the characteristics of HCCs categorized as LR-M with HCCs categorized as LR-4 or LR-5 (LR-4/5) using the LI-RADS version 2018 and evaluate the relationship of these categories with the risk of early recurrence after curative resections of single HCCs.
Retrospective.
Two hundred and eighty-one patients (mean age, 57 years; 191 men and 90 women) who underwent curative resections for single HCCs and preoperative contrast-enhanced MRI between 2015 and 2017.
FIELD STRENGTH/SEQUENCE: 3T Dual gradient-echo T WI with in- and opposed-phase, turbo spin-echo T WI, diffusion-weighted echo-planar images, and three-dimensional gradient-echo T WI before and after administration of contrast agent.
MRI features according to the LI-RADS version 2018 were evaluated and LI-RADS category were assigned for each observation. Clinical, imaging, and histopathological features were compared based on LI-RADS categorization. Early recurrence rates (<2 years) and associated factors were also evaluated.
Fisher's exact test, two-sample t test after satisfying assumption of normality through Shapiro-Wilk test, Fleiss κ coefficient, Cox proportional hazards regression analysis, Kaplan-Meier method, and log-rank test.
Forty-one HCCs (14.6%) were categorized as LR-M and 240 HCCs (85.4%) were categorized as LR-4/5. LR-M HCCs showed poorer differentiation than LR-4/5 HCCs. In the multivariate analysis, the LR-M category was an independent predictor for early recurrence (hazard ratio, 1.904; 95% confidence interval, 1.024-3.542; P < 0.05). Early recurrence rates were significantly higher in patients with LR-M HCCs than in patients with LR-4/5 HCCs (32.0% vs. 18.4%, respectively, P < 0 05).
Compared to LR-4/5 HCCs, LR-M HCCs were associated with poorer tumor differentiation and higher early recurrence rates after curative resections of single HCCs.
3 Technical Efficacy Stage: 2.
根据肝脏影像报告和数据系统（LI-RADS），LI-RADS 类别 M（LR-M）可能或肯定为恶性，但对肝细胞癌（HCC）不具有特异性，不能排除 HCC。目前仍存在知识空白，包括这些被归类为 LR-M 的 HCC 的特征和 HCC 复发情况。
使用 LI-RADS 版本 2018 比较被归类为 LR-M 的 HCC 与被归类为 LR-4 或 LR-5（LR-4/5）的 HCC 的特征，并评估这些类别与单个 HCC 根治性切除术后早期复发的风险之间的关系。
回顾性。
281 名接受单发性 HCC 根治性切除术并于 2015 年至 2017 年期间进行术前对比增强 MRI 的患者（平均年龄 57 岁；191 名男性和 90 名女性）。
场强/序列：3T 双梯度回波 TWI 同相位和反相位、涡轮自旋回波 TWI、扩散加权回波平面成像，以及三维梯度回波 TWI 于造影剂给药前后。
根据 LI-RADS 版本 2018 评估 MRI 特征，并为每个观察结果分配 LI-RADS 类别。基于 LI-RADS 分类比较临床、影像学和组织病理学特征。还评估了早期复发率（<2 年）及其相关因素。
Fisher 确切检验，Shapiro-Wilk 检验后满足正态性假设的两样本 t 检验，Fleiss κ 系数，Cox 比例风险回归分析，Kaplan-Meier 法和对数秩检验。
41 个 HCC（14.6%）被归类为 LR-M，240 个 HCC（85.4%）被归类为 LR-4/5。LR-M HCC 的分化程度比 LR-4/5 HCC 差。多因素分析显示，LR-M 类别是早期复发的独立预测因子（危险比，1.904；95%置信区间，1.024-3.542；P<0.05）。LR-M HCC 患者的早期复发率明显高于 LR-4/5 HCC 患者（分别为 32.0%和 18.4%，P<0.05）。
与 LR-4/5 HCC 相比，LR-M HCC 与单个 HCC 根治性切除术后肿瘤分化程度较差和早期复发率较高相关。
3 技术功效分期：2。
