Pan Junhan, Song Mengchen, Yang Lili, Zhao Yanci, Zhu Yanyan, Wang Meng, Chen Feng
Department of Radiology, Zhejiang University School of Medicine First Affiliated Hospital, No.79 Qingchun Road, Hangzhou, 310003, China.
Department of Radiology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, 310003, China.
Eur Radiol. 2023 Aug;33(8):5801-5811. doi: 10.1007/s00330-023-09487-2. Epub 2023 Mar 10.
To evaluate the value of using enhancing capsule (EC) or modified capsule appearance as a major feature in LI-RADS for diagnosing HCC ≤ 3.0 cm on gadoxetate disodium-enhanced MRI (Gd-EOB-MRI), and to explore the relationship between the imaging features and the histological fibrous capsule.
This retrospective study enrolled 342 hepatic lesions ≤ 3.0 cm in 319 patients that underwent Gd-EOB-MRIs from January 2018 to March 2021. During dynamic phases and hepatobiliary phase, the modified capsule appearance added the nonenhancing capsule (NEC) (modified LI-RADS + NEC) or corona enhancement (CoE) (modified LI-RADS + CoE) to EC as an alternative capsule appearance. Inter-reader agreement of imaging features was assessed. The diagnostic performances of LI-RADS, LI-RADS with EC ignored, and two modified LI-RADS were compared, followed by Bonferroni correction. Multivariable regression analysis was performed to identify the independent features associated with the histological fibrous capsule.
The inter-reader agreement on EC (0.64) was lower than that on the NEC alternative (0.71) but better than that on CoE alternative (0.58). For HCC diagnosis, compared to LI-RADS, LI-RADS with EC ignored showed significantly lower sensitivity (72.7% vs. 67.4%, p < 0.001) with comparable specificity (89.3% vs. 90.7%, p = 1.000). Two modified LI-RADS showed slightly higher sensitivity and lower specificity than LI-RADS, without statistical significance (all p ≥ 0.006). The AUC was highest with modified LI-RADS + NEC (0.82). Both EC and NEC were significantly associated with the fibrous capsule (p < 0.05).
EC appearance improved the diagnostic sensitivity of LI-RADS for HCC ≤ 3.0 cm on Gd-EOB-MRI. Considering NEC as an alternative capsule appearance allowed for better inter-reader reliability and comparable diagnostic ability.
• Using the enhancing capsule as a major feature in LI-RADS significantly improved the sensitivity of diagnosing HCC ≤ 3.0 cm without reducing specificity on gadoxetate disodium-enhanced MRI. • Compared to the corona enhancement, the nonenhancing capsule might be a preferable alternative capsule appearance for diagnosing HCC ≤ 3.0 cm. • Capsule appearance should be considered a major feature in LI-RADS for diagnosing HCC ≤ 3.0 cm, regardless whether the capsule appears to be enhancing or nonenhancing.
评估在钆塞酸二钠增强磁共振成像（Gd-EOB-MRI）中，使用强化包膜（EC）或改良包膜表现作为肝脏影像报告和数据系统（LI-RADS）诊断直径≤3.0 cm肝细胞癌（HCC）的主要特征的价值，并探讨影像特征与组织学纤维包膜之间的关系。
本回顾性研究纳入了2018年1月至2021年3月期间接受Gd-EOB-MRI检查的319例患者的342个直径≤3.0 cm的肝脏病变。在动态期和肝胆期，改良包膜表现将无强化包膜（NEC）（改良LI-RADS+NEC）或晕环强化（CoE）（改良LI-RADS+CoE）添加到EC中作为替代包膜表现。评估了阅片者之间对影像特征的一致性。比较了LI-RADS、忽略EC的LI-RADS以及两种改良LI-RADS的诊断性能，随后进行Bonferroni校正。进行多变量回归分析以确定与组织学纤维包膜相关的独立特征。
阅片者之间对EC的一致性（0.64）低于对NEC替代表现的一致性（0.71），但优于对CoE替代表现的一致性（0.58）。对于HCC诊断，与LI-RADS相比，忽略EC的LI-RADS显示出显著更低的敏感性（72.7%对67.4%，p<0.001），而特异性相当（89.3%对90.7%，p=1.000）。两种改良LI-RADS显示出比LI-RADS略高的敏感性和略低的特异性，但无统计学意义（所有p≥0.006）。改良LI-RADS+NEC的曲线下面积（AUC）最高（0.82）。EC和NEC均与纤维包膜显著相关（p<0.05）。
EC表现提高了LI-RADS对Gd-EOB-MRI上直径≤3.0 cm HCC的诊断敏感性。将NEC视为替代包膜表现可实现更好的阅片者间可靠性和相当的诊断能力。
• 在LI-RADS中使用强化包膜作为主要特征可显著提高诊断直径≤3.0 cm HCC的敏感性，且在钆塞酸二钠增强磁共振成像上不降低特异性。• 与晕环强化相比，无强化包膜可能是诊断直径≤3.0 cm HCC更优的替代包膜表现。• 在LI-RADS中，无论包膜表现为强化或无强化，都应将其视为诊断直径≤3.0 cm HCC的主要特征。
