Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China.
Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fujian, China.
Abdom Radiol (NY). 2022 Mar;47(3):957-968. doi: 10.1007/s00261-021-03380-6. Epub 2021 Dec 28.
To identify the reliable imaging features and added-value of ancillary imaging features for differentiating hepatocellular carcinoma (HCC) and intrahepatic mass-forming cholangiocarcinoma (IMCC) assigned to LI-RADS M on Gd-BOPTA-enhanced MRI.
This retrospective study included 116 liver observations assigned to LI-RADS M, including 82 HCC and 34 IMCC histologically confirmed. Before and after adding ancillary imaging features, all variables with a p-value of < 0.05 in univariable analysis were entered into a multivariable logistic regression analysis to build diagnostic model 1 and model 2 to find reliable predictors of HCC diagnosis. Receiver operating characteristic (ROC) analysis and the DeLong test were used to compare the two models.
Forty-nine of 82(59.8%) HCCs had a considerably higher frequency of enhancing "capsule" compared with IMCCs (p < 0.001). Based on LI-RADS major and LR-M features and clinical-pathologic factors, an elevated AFP level (OR = 10.676, 95%CI = 2.125-4.470, p = 0.004) and enhancing "capsule" (OR = 20.558, 95%CI = 4.470-94.550, p < 0.001) were extracted as independent risk factors in Model 1. After adding ancillary imaging features, Male (OR = 23.452, 95%CI = 1.465-375.404, p = 0.026), enhancing "capsule" (OR = 13.161, 95%CI = 1.725-100.400, p = 0.013), septum (OR = 17.983, 95%CI = 1.049-308.181, p = 0.046), small-scale central HBP hyperintensity (OR = 44.386, 95%CI = 1.610-1223.484, p = 0.025) were confirmed as independent significant variables associated with HCC. Model 2 demonstrated significantly superior AUC (0.918 vs 0.845, p = 0.021) compared with Model 1. When any two or more predictors in model 2 were satisfied, sensitivity was 91.46%, and accuracy was at the top (87.93%).
Enhancing "capsule" was a reliable imaging feature to help identify HCC. Adding ancillary imaging features improved sensitivity and accuracy for HCC diagnosis with differentiation from IMCC in LR-M.
确定 Gd-BOPTA 增强 MRI 上 LI-RADS M 分配的肝细胞癌 (HCC) 和肝内肿块形成型胆管细胞癌 (IMCC) 的可靠影像学特征和辅助影像学特征的附加值，用于区分 HCC 和 IMCC。
本回顾性研究纳入了 116 个肝脏观察结果，其中 82 个 HCC 和 34 个 IMCC 经组织学证实。在添加辅助成像特征之前和之后，单变量分析中 p 值<0.05 的所有变量均被纳入多变量逻辑回归分析，以建立诊断模型 1 和模型 2，以寻找 HCC 诊断的可靠预测因子。使用受试者工作特征 (ROC) 分析和 DeLong 检验比较两个模型。
与 IMCC 相比，82 个 HCC 中有 49 个（59.8%） HCC 出现明显更高频率的增强“包膜”（p<0.001）。基于 LI-RADS 主要和 LR-M 特征以及临床病理因素，AFP 水平升高（OR=10.676，95%CI=2.125-4.470，p=0.004）和增强“包膜”（OR=20.558，95%CI=4.470-94.550，p<0.001）被提取为模型 1 中的独立危险因素。在添加辅助成像特征后，男性（OR=23.452，95%CI=1.465-375.404，p=0.026）、增强“包膜”（OR=13.161，95%CI=1.725-100.400，p=0.013）、隔膜（OR=17.983，95%CI=1.049-308.181，p=0.046）、小范围中央 HBP 高信号（OR=44.386，95%CI=1.610-1223.484，p=0.025）被证实与 HCC 相关的独立显著变量。模型 2 显示 AUC（0.918 与 0.845，p=0.021）显著优于模型 1。当模型 2 中满足任意两个或更多预测因子时，敏感性为 91.46%，准确性最高（87.93%）。
增强“包膜”是一种可靠的影像学特征，可以帮助识别 HCC。在 LR-M 中，添加辅助成像特征可提高 HCC 诊断的敏感性和准确性，有助于与 IMCC 区分。
