Choi Se Jin, Choi Sang Hyun, Kim Dong Wook, Kwag Minha, Byun Jae Ho, Won Hyung Jin, Shin Yong Moon
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
J Hepatol. 2023 Mar;78(3):596-603. doi: 10.1016/j.jhep.2022.11.006. Epub 2022 Nov 17.
BACKGROUND & AIMS: The Liver Reporting and Data System (LI-RADS) version 2018 simplified the definition of threshold growth to '≥50% size increase in a mass in ≤6 months'. However, the diagnostic value of threshold growth for hepatocellular carcinoma (HCC) remained unclear. We evaluated the value of threshold growth, as defined by LI-RADS v2018, in diagnosing HCCs.
Patients who underwent preoperative gadoxetate disodium-enhanced MRI because of the presence of LI-RADS category 2, 3, or 4 rather than category 5 on prior CT/MRI between January 2017 and December 2020 were retrospectively evaluated. Pathologic or clinical diagnoses were used as reference standards. Imaging features were evaluated by three readers according to LI-RADS v2018. The frequency and diagnostic odds ratio of threshold growth were calculated. The diagnostic performance of LI-RADS category 5 was separately evaluated when threshold growth was and was not considered a major feature, and results were compared using generalized estimation equations. Subgroups of patients who underwent CT/MRI during the previous 3-6 months were analyzed.
Analysis of 340 observations in 243 patients found that the frequency of threshold growth was 18.8% and it gradually increased over time. Threshold growth was significantly associated with HCC (diagnostic odds ratio 5.2; 95% CI 2.1-12.7; p <0.001). Use of threshold growth as a major feature significantly increased sensitivity in both the overall (66.4% vs. 57.3%, p <0.001) and subgroup (73.4% vs. 58.2%, p <0.001) cohorts, but had no effect on specificity in either the overall (97.5% vs. 98.3%, p = 0.319) or subgroup (95.9% vs. 98.0%, p = 0.323) cohorts.
The revised threshold growth of LI-RADS v2018 was significantly associated with HCC. Use of threshold growth as a major diagnostic feature of HCC can improve the sensitivity of LI-RADS v2018.
We found that the revised threshold growth in the Liver Imaging Reporting and Data System version 2018 (LI-RADS v2018) was a significant predictor of hepatocellular carcinoma (HCC). The use of threshold growth as a major imaging feature of HCC significantly increased the sensitivity of LI-RADS v2018, especially small HCCs (≤3.0 cm), compared with its non-use. Because these small HCCs are eligible for curative treatments, the additional detection of small HCCs is clinically meaningful.
《肝脏报告与数据系统》（LI-RADS）2018版将阈值生长的定义简化为“在≤6个月内肿块大小增加≥50%”。然而，阈值生长对肝细胞癌（HCC）的诊断价值仍不明确。我们评估了LI-RADS v2018定义的阈值生长在诊断HCC中的价值。
回顾性评估2017年1月至2020年12月期间因之前CT/MRI显示为LI-RADS 2类、3类或4类而非5类而接受术前钆塞酸二钠增强MRI检查的患者。病理或临床诊断用作参考标准。三位阅片者根据LI-RADS v2018评估影像特征。计算阈值生长的频率和诊断优势比。当阈值生长被视为和不被视为主要特征时，分别评估LI-RADS 5类的诊断性能，并使用广义估计方程比较结果。对在过去3至6个月内接受CT/MRI检查的患者亚组进行分析。
对243例患者的340次观察分析发现，阈值生长的频率为18.8%，且随时间逐渐增加。阈值生长与HCC显著相关（诊断优势比5.2；95%CI 2.1 - 12.7；p<0.001）。将阈值生长用作主要特征在总体队列（66.4%对57.3%，p<0.001）和亚组队列（73.4%对58.2%，p<0.001）中均显著提高了敏感性，但在总体队列（97.5%对98.3%，p = 0.319）或亚组队列（95.9%对98.0%，p = 0.323）中对特异性均无影响。
LI-RADS v2018修订后的阈值生长与HCC显著相关。将阈值生长用作HCC的主要诊断特征可提高LI-RADS v2018的敏感性。
我们发现《肝脏影像报告与数据系统》2018版（LI-RADS v2018）修订后的阈值生长是肝细胞癌（HCC）的重要预测指标。与不使用相比，将阈值生长用作HCC的主要影像特征显著提高了LI-RADS v2018的敏感性，尤其是对小HCC（≤3.0 cm）。由于这些小HCC适合进行根治性治疗，额外检测出小HCC具有临床意义。
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