基于钆塞酸二钠增强磁共振成像的2018版肝脏影像报告和数据系统（LI-RADS）用于直径小于1.0厘米的肝细胞癌。
LI-RADS version 2018 for hepatocellular carcinoma < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging.
作者信息
Jang Hyeon Ji, Choi Sang Hyun, Choi Se Jin, Choi Won-Mook, Byun Jae Ho, Won Hyung Jin, Shin Yong Moon
机构信息
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, Republic of Korea.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
出版信息
Eur Radiol. 2023 Aug;33(8):5792-5800. doi: 10.1007/s00330-023-09554-8. Epub 2023 Apr 5.
OBJECTIVES
We aimed to develop and evaluate a modified Liver Imaging Reporting and Data System (LI-RADS) version 2018 using significant ancillary features for diagnosing hepatocellular carcinoma (HCC) < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging (MRI).
METHODS
Patients who underwent preoperative gadoxetate disodium-enhanced MRI for focal solid nodules < 2.0 cm within 1 month of MRI between January 2016 and December 2020 were retrospectively analyzed. Major and ancillary features were compared between HCCs of < 1.0 cm and 1.0-1.9 cm using the chi-square test. Significant ancillary features associated with HCC < 1.0 cm were determined by univariable and multivariable logistic regression analysis. The sensitivity and specificity of LR-5 were compared between LI-RADS v2018 and our modified LI-RADS (applying the significant ancillary feature) using generalized estimating equations.
RESULTS
Of 796 included nodules, 248 were < 1.0 cm and 548 were 1.0-1.9 cm. HCC < 1.0 cm less frequently showed an enhancing capsule (7.1% vs. 31.1%, p < .001) and threshold growth (0% vs. 8.3%, p = .007) than HCC of 1.0-1.9 cm. Restricted diffusion was the only ancillary feature significant for diagnosing HCC < 1.0 cm (adjusted odds ratio = 11.50, p < .001). In the diagnosis of HCC, our modified LI-RADS using restricted diffusion had significantly higher sensitivity than LI-RADS v2018 (61.8% vs. 53.5%, p < .001), with similar specificity (97.3% vs. 97.8%, p = .157).
CONCLUSION
Restricted diffusion was the only significant independent ancillary feature for diagnosing HCC < 1.0 cm. Our modified LI-RADS using restricted diffusion can improve the sensitivity for HCC < 1.0 cm.
KEY POINTS
• The imaging features of hepatocellular carcinoma (HCC) < 1.0 cm differed from those of HCC of 1.0-1.9 cm. • Restricted diffusion was the only significant independent ancillary feature for HCC < 1.0 cm. • Modified Liver Imaging Reporting and Data System (LI-RADS) with the addition of restricted diffusion can improve the sensitivity for HCC < 1.0 cm.
目的
我们旨在开发并评估一种改良的2018版肝脏影像报告和数据系统（LI-RADS），该系统使用重要的辅助特征来诊断钆塞酸二钠增强磁共振成像（MRI）上直径小于1.0 cm的肝细胞癌（HCC）。
方法
回顾性分析2016年1月至2020年12月期间在MRI检查后1个月内对直径小于2.0 cm的局灶性实性结节进行术前钆塞酸二钠增强MRI检查的患者。使用卡方检验比较直径小于1.0 cm和1.0 - 1.9 cm的HCC的主要和辅助特征。通过单变量和多变量逻辑回归分析确定与直径小于1.0 cm的HCC相关的重要辅助特征。使用广义估计方程比较LI-RADS v2018和我们改良的LI-RADS（应用重要辅助特征）之间LR-5的敏感性和特异性。
结果
在纳入的796个结节中，248个直径小于1.0 cm，548个直径为1.0 - 1.9 cm。与直径1.0 - 1.9 cm的HCC相比，直径小于1.0 cm的HCC出现强化包膜（7.1%对31.1%，p <.001）和阈值生长（0%对8.3%，p =.007）的频率较低。扩散受限是诊断直径小于1.0 cm的HCC的唯一显著辅助特征（调整后的优势比 = 11.50，p <.001）。在HCC的诊断中，我们使用扩散受限的改良LI-RADS的敏感性显著高于LI-RADS v2018（61.8%对53.5%，p <.001），特异性相似（97.3%对97.8%，p =.157）。
结论
扩散受限是诊断直径小于1.0 cm的HCC的唯一显著独立辅助特征。我们使用扩散受限的改良LI-RADS可以提高对直径小于1.0 cm的HCC的诊断敏感性。
关键点
• 直径小于1.0 cm的肝细胞癌（HCC）的影像学特征与直径1.0 - 1.9 cm的HCC不同。• 扩散受限是直径小于1.0 cm的HCC的唯一显著独立辅助特征。• 增加了扩散受限的改良肝脏影像报告和数据系统（LI-RADS）可以提高对直径小于1.0 cm的HCC的诊断敏感性。
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