Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
Present affiliation: Peterborough Regional Health Centre, Peterborough, ON, Canada.
AJR Am J Roentgenol. 2022 Mar;218(3):462-470. doi: 10.2214/AJR.21.26376. Epub 2021 Oct 13.
Reported rates of hepatocellular carcinoma (HCC) for LR-2 and LR-3 observations are generally greater than those expected on the basis of clinical experience, possibly reflecting some studies' requirement for pathologic reference. The purpose of this study was to determine rates of progression to higher LI-RADS categories of LR-2 and LR-3 observations in patients at high risk of HCC. This retrospective study included 91 patients (64 men, 27 women; mean age, 62 years) at high risk of HCC who had clinically reported LR-2 ( = 55) or LR-3 ( = 36) observations on MRI who also underwent follow-up CT or MRI at least 12 months after the observation was made. A study coordinator annotated the location of a single LR-2 or LR-3 observation per patient on the basis of the clinical reports. Using LI-RADS version 2018 criteria, two radiologists independently assigned LI-RADS categories on the follow-up examinations. Progression rates from LR-2 or LR-3 to higher categories were determined. A post hoc consensus review was performed of observations that progressed to LR-4 or LR-5. Subgroup analyses were performed with respect to presence of prior HCC ( = 34) or a separate baseline LR-5 observation ( = 12). For LR-2 observations, the rate of progression to LR-4 was 0.0% (95% CI, 0.0-6.7%) and to LR-5 was 3.6% (95% CI, 0.4-13.1%) for both readers. For LR-3 observations, the rate of progression to LR-4 was 22.2% (95% CI, 9.6-43.8%) and to LR-5 was 11.1% (95% CI, 3.0-28.4%) for both readers. Fourteen observations progressed to LR-4 or LR-5 for both readers. Post hoc analysis revealed no instances of progression from LR-2 to LR-4; two, from LR-2 to LR-5; eight, from LR-3 to LR-4; and four, from LR-3 to LR-5. The progression rate from LR-3 to LR-5 was higher ( < .001) among patients with (100.0%) than those without (3.0%) a separate baseline LR-5 observation for both readers. The progression rate from LR-2 to LR-5 was not associated with a separate baseline LR-5 observation for either reader ( = .30). Progression rates were not different (p > .05) between patients with versus those without prior HCC. On the basis of progression to LR-4 or LR-5, LR-2 and LR-3 observations had lower progression rates than reported in studies incorporating pathology results in determining progression. The findings refine understanding of the clinical significance of LR-2 and LR-3 observations.
报告的肝细胞癌 (HCC) 发生率对于 LR-2 和 LR-3 观察结果通常高于临床经验基础上的预期，这可能反映了一些研究对病理参考的要求。本研究旨在确定在 HCC 高危患者中，LR-2 和 LR-3 观察结果进展为更高 LI-RADS 类别的发生率。这项回顾性研究纳入了 91 名（64 名男性，27 名女性；平均年龄 62 岁）HCC 高危患者，他们在 MRI 上有临床报告的 LR-2（=55）或 LR-3（=36）观察结果，并且在观察结果后至少 12 个月进行了后续 CT 或 MRI 检查。一名研究协调员根据临床报告，在每位患者的单个 LR-2 或 LR-3 观察结果上进行标注。使用 LI-RADS 版本 2018 标准，两名放射科医生独立对随访检查进行 LI-RADS 类别分配。确定了从 LR-2 或 LR-3 进展到更高类别的发生率。对进展为 LR-4 或 LR-5 的观察结果进行了事后共识审查。根据是否存在先前的 HCC（=34）或单独的基线 LR-5 观察结果（=12）进行了亚组分析。对于 LR-2 观察结果，两位读者的 LR-4 进展率为 0.0%（95%CI，0.0-6.7%），LR-5 进展率为 3.6%（95%CI，0.4-13.1%）。对于 LR-3 观察结果，两位读者的 LR-4 进展率为 22.2%（95%CI，9.6-43.8%），LR-5 进展率为 11.1%（95%CI，3.0-28.4%）。对于两位读者，共有 14 个观察结果进展为 LR-4 或 LR-5。事后分析显示没有从 LR-2 进展为 LR-4 的情况；2 个从 LR-2 进展为 LR-5；8 个从 LR-3 进展为 LR-4；4 个从 LR-3 进展为 LR-5。在有（100.0%）和没有（3.0%）单独基线 LR-5 观察结果的患者中，LR-3 进展为 LR-5 的发生率更高（<.001），对于两位读者均如此。LR-2 进展为 LR-5 与是否存在单独的基线 LR-5 观察结果无关（=0.30）。对于两位读者，LR-2 到 LR-5 的进展率与 HCC 病史无差异（p＞0.05）。基于 LR-4 或 LR-5 的进展，LR-2 和 LR-3 观察结果的进展率低于纳入病理结果以确定进展的研究报告的进展率。这些发现细化了对 LR-2 和 LR-3 观察结果临床意义的理解。
