From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-Gu, Seoul 05505, Korea.
Radiology. 2022 Dec;305(3):614-622. doi: 10.1148/radiol.220659. Epub 2022 Aug 16.
Background Although various modifications to the Liver Imaging Reporting and Data System (LI-RADS) at gadoxetic acid-enhanced MRI have been suggested, LI-RADS shows suboptimal sensitivity for hepatocellular carcinoma (HCC) and is perceived to be too complex. Purpose To evaluate clinical usefulness of a simplified LI-RADS for diagnosing HCCs of 30 mm or smaller at gadoxetic acid-enhanced MRI. Materials and Methods Patients who underwent gadoxetic acid-enhanced MRI examination and subsequent resection, transplantation, or biopsy for focal solid nodules of 30 mm or smaller between January 2019 and December 2020 at a single tertiary referral institution were retrospectively analyzed. Two strategies for simplified LI-RADS using one size criterion (≥10 mm) were evaluated (strategy A, using classifications for nodules of 10-19 mm for nodules both 10-19 mm and ≥20 mm; strategy B, using classifications for nodules ≥20 mm for nodules both 10-19 mm and ≥20 mm). Multivariable analysis was performed to determine significant ancillary features for HCC. Generalized estimating equations were used to compare diagnostic performance for LR-5 (definite HCC) between LI-RADS version 2018 and simplified LI-RADS. The time required for LI-RADS category assignment was compared between the two systems with use of a paired test. Results A total of 645 nodules from 510 patients (mean age ± SD, 60 years ± 10; 393 men) were evaluated. Compared with strategy A, strategy B had a higher sensitivity of 74% (347 of 470 nodules [95% CI: 70, 78]) vs 73% (342 of 470 nodules [95% CI: 69, 77]) ( = .02) with the same specificity of 96% (168 of 175 nodules [95% CI: 92, 98]) vs 96% (168 of 175 nodules [95% CI: 92, 98]) ( > .99). In strategy B, transitional phase hypointensity was an independent ancillary feature for HCC ( = .04) in LR-4 of at least 10 mm with arterial phase hyperenhancement and no other major features. In all 645 nodules, simplified LI-RADS with use of both strategy B and transitional phase hypointensity had a higher sensitivity of 82% (387 of 470 nodules [95% CI: 79, 86]) vs 73% (343 of 470 nodules [95% CI: 69, 77]) ( < .001) than LI-RADS version 2018, without lower specificity (94%, 165 of 175 nodules [95% CI: 90, 97] vs 96%, 168 of 175 nodules [95% CI: 92, 98], = .08). Compared with LI-RADS version 2018, simplified LI-RADS reduced the time for LI-RADS category assignment (44 seconds ± 23 vs 74 seconds ± 22, < .001). Conclusion A simplified Liver Imaging Reporting and Data System was found to be clinically useful for diagnosing hepatocellular carcinomas of 30 mm or smaller at gadoxetic acid-enhanced MRI. © RSNA, 2022
背景 虽然在钆塞酸增强 MRI 上对 Liver Imaging Reporting and Data System（LI-RADS）进行了各种修改，但 LI-RADS 对肝细胞癌（HCC）的敏感性不够，并且被认为过于复杂。目的 评估简化的 LI-RADS 在诊断钆塞酸增强 MRI 上直径为 30mm 或更小的 HCC 方面的临床应用价值。材料与方法 回顾性分析了 2019 年 1 月至 2020 年 12 月期间在一家三级转诊机构因直径为 30mm 或更小的局灶性实性结节而接受钆塞酸增强 MRI 检查并随后接受切除、移植或活检的患者。评估了两种简化 LI-RADS 的策略，使用一个大小标准（≥10mm）（策略 A，使用 10-19mm 和≥20mm 结节的分类用于 10-19mm 和≥20mm 的结节；策略 B，使用≥20mm 结节的分类用于 10-19mm 和≥20mm 的结节）。采用多变量分析确定 HCC 的显著辅助特征。采用广义估计方程比较 LI-RADS 版本 2018 与简化 LI-RADS 对 LR-5（明确 HCC）的诊断性能。使用配对 t 检验比较两种系统的 LI-RADS 类别分配时间。结果 共评估了 510 例患者（平均年龄±标准差，60 岁±10 岁；男性 393 例）的 645 个结节。与策略 A 相比，策略 B 的敏感性更高，为 74%（470 个结节中的 347 个[95%CI：70，78]）与 73%（470 个结节中的 342 个[95%CI：69，77]）（=.02），特异性相同，为 96%（175 个结节中的 168 个[95%CI：92，98]）与 96%（175 个结节中的 168 个[95%CI：92，98]）（>.99）。在策略 B 中，过渡相低信号是动脉期高增强且无其他主要特征的至少 10mm 的 LR-4 中 HCC 的独立辅助特征（=.04）。在所有 645 个结节中，使用策略 B 和过渡相低信号的简化 LI-RADS 的敏感性更高，为 82%（470 个结节中的 387 个[95%CI：79，86]）与 73%（470 个结节中的 343 个[95%CI：69，77]）（<.001），特异性无差异，为 94%（175 个结节中的 165 个[95%CI：90，97]）与 96%（175 个结节中的 168 个[95%CI：92，98]）（=.08）。与 LI-RADS 版本 2018 相比，简化 LI-RADS 减少了 LI-RADS 类别分配的时间（44 秒±23 秒与 74 秒±22 秒，<.001）。结论 简化的 Liver Imaging Reporting and Data System 在诊断钆塞酸增强 MRI 上直径为 30mm 或更小的 HCC 方面具有临床应用价值。
