Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Department of Statistics and Data Science, Korea National Open University, Main Building 320, 86 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea.
Abdom Radiol (NY). 2022 Jul;47(7):2289-2298. doi: 10.1007/s00261-022-03538-w. Epub 2022 May 6.
We aimed to determine a new strategy for Liver Imaging Reporting and Data System category M (LR-M) criteria to improve the diagnosis of HCC ≤ 3.0 cm on magnetic resonance imaging (MRI).
A total of 463 pathologically confirmed hepatic observations ≤ 3.0 cm (375 HCCs, 32 other malignancies, 56 benignities) in 384 patients at risk of HCC who underwent gadoxetate-enhanced MRI were retrospectively analyzed. Two radiologists evaluated the presence of major, ancillary, and LR-M features according to LI-RADS v2018. Of the ten LR-M features, those significantly associated with non-HCC malignancy were identified using multivariable logistic regression analysis, and new LR-M criteria for improving the diagnosis of HCC were investigated. Generalized estimating equations were used to compare sensitivity and specificity of LR-5 for diagnosing HCC using the new LR-M criteria with values calculated using the original LR-M criteria. p < 0.05 was considered to indicate a significant difference.
Of ten LR-M features, rim arterial-phase hyperenhancement, delayed central enhancement, targetoid restriction, and targetoid transitional-phase/hepatobiliary-phase appearance were independently significantly associated with non-HCC malignancy (adjusted odds ratio ≥ 6.2; p ≤ 0.02). Using the new LR-M criteria (two or more of these significant features), the sensitivity of LR-5 for diagnosing HCC was higher than that with the original LR-M criteria (69% [95% confidence interval 64-73%] vs. 65% [61-70%], p = 0.002), whereas the specificity was similar (90% [82-95%] vs. 92% [83-96%], p = 0.28).
The new LR-M criteria (two or more significant features) can improve the sensitivity of LR-5 for diagnosing HCC ≤ 3.0 cm, without compromising specificity.
我们旨在确定一种新的 Liver Imaging Reporting and Data System（LI-RADS）类别 M（LR-M）标准策略，以提高磁共振成像（MRI）上≤3.0cm 的 HCC 的诊断准确性。
回顾性分析了 384 例 HCC 高危患者的 463 个病理证实的≤3.0cm 的肝观察结果（375 个 HCC、32 个其他恶性肿瘤、56 个良性病变）。两名放射科医生根据 LI-RADS v2018 评估主要、辅助和 LR-M 特征的存在情况。使用多变量逻辑回归分析确定与非 HCC 恶性肿瘤显著相关的十个 LR-M 特征，并研究了改善 HCC 诊断的新 LR-M 标准。使用广义估计方程比较了使用新 LR-M 标准计算的 LR-5 对诊断 HCC 的敏感性和特异性与使用原始 LR-M 标准计算的值。p<0.05 被认为具有统计学意义。
十个 LR-M 特征中，边缘动脉期强化、延迟中央强化、靶样限制和靶样过渡相/肝胆相出现与非 HCC 恶性肿瘤独立显著相关（调整优势比≥6.2；p≤0.02）。使用新的 LR-M 标准（两个或更多这些显著特征），LR-5 诊断 HCC 的敏感性高于原始 LR-M 标准（69%[95%置信区间 64-73%] vs. 65%[61-70%]，p=0.002），而特异性相似（90%[82-95%] vs. 92%[83-96%]，p=0.28）。
新的 LR-M 标准（两个或更多显著特征）可以提高 LR-5 诊断≤3.0cm HCC 的敏感性，而不会影响特异性。
