Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan.
Abdom Radiol (NY). 2023 Aug;48(8):2557-2569. doi: 10.1007/s00261-023-03964-4. Epub 2023 May 29.
To assess inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein (TIV) from bland thrombus on gadoxetic acid-enhanced magnetic resonance imaging (Gx-MRI). Secondarily, to determine whether a multi-feature model improves accuracy compared to LI-RADS.
We retrospectively identified consecutive patients at risk for hepatocellular carcinoma with venous occlusion(s) reported on Gx-MRI. Five radiologists independently classified each occlusion as TIV or bland thrombus using the LI-RADS TIV criterion (enhancing soft tissue in vein). They also evaluated imaging features suggestive of TIV or bland thrombus. Intra-class correlation coefficient (ICC) was calculated for individual features. A multi-feature model was developed based on consensus scores of features with > 5% consensus prevalence and > 0.40 ICC. Sensitivity and specificity of the LI-RADS criterion and of the cross-validated multi-feature model were compared.
Ninety-eight patients with 103 venous occlusions (58 TIV, 45 bland thrombus) were included. The LI-RADS criterion provided 0.63 ICC and, depending on the reader, 0.62-0.93 sensitivity and 0.87-1.00 specificity. Five other features had > 5% consensus prevalence and > 0.40 ICC, including three LI-RADS suggestive features and two non-LI-RADS features. The optimal multi-feature model incorporated the LI-RADS criterion and one LI-RADS suggestive feature (occluded or obscured vein contiguous with malignant parenchymal mass). After cross-validation, the multi-feature model did not improve sensitivity or specificity compared to the LI-RADS criterion (P = 0.23 and 0.25, respectively).
Using Gx-MRI, the LI-RADS criterion for TIV provides substantial inter-observer agreement, variable sensitivity, and high specificity for differentiating TIV from bland thrombus. A cross-validated multi-feature model did not improve diagnostic performance.
评估 LI-RADS v2018 区分钆塞酸增强磁共振成像（Gx-MRI）中肿瘤在静脉内（TIV）与单纯性血栓的观察者间一致性和准确性。其次，确定多特征模型是否比 LI-RADS 提高准确性。
我们回顾性地在 Gx-MRI 上识别出有静脉闭塞报道的肝细胞癌高危患者。五位放射科医生使用 LI-RADS TIV 标准（静脉内强化软组织）独立对每个闭塞进行分类，将其分为 TIV 或单纯性血栓。他们还评估了提示 TIV 或单纯性血栓的影像学特征。计算个体特征的组内相关系数（ICC）。基于>5%共识患病率和>0.40 ICC 的特征共识评分，建立多特征模型。比较 LI-RADS 标准和交叉验证多特征模型的敏感性和特异性。
共纳入 98 例患者，103 个静脉闭塞（58 个 TIV，45 个单纯性血栓）。LI-RADS 标准提供 0.63 ICC，根据观察者的不同，敏感性为 0.62-0.93，特异性为 0.87-1.00。其他五个特征的共识患病率>5%，ICC>0.40，包括三个 LI-RADS 提示特征和两个非 LI-RADS 特征。最优多特征模型纳入 LI-RADS 标准和一个 LI-RADS 提示特征（与恶性实质肿块连续的闭塞或模糊静脉）。交叉验证后，与 LI-RADS 标准相比，多特征模型并未提高敏感性或特异性（P=0.23 和 0.25）。
使用 Gx-MRI，LI-RADS 标准对于 TIV 的区分具有良好的观察者间一致性、可变的敏感性和高特异性。交叉验证的多特征模型并未提高诊断性能。
