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 Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, 05505, Korea.
Eur Radiol. 2024 Jan;34(1):465-474. doi: 10.1007/s00330-023-10014-6. Epub 2023 Aug 3.
To evaluate the diagnostic performance for hepatocellular carcinoma (HCC) detection of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 on gadoxetic acid-enhanced MRI, comparing liver transplant candidates (LT group) with patients who underwent surgical resection (SR group), and to determine significant clinical factors for diagnostic performance of LI-RADS v2018.
Patients who underwent gadoxetic acid-enhanced MRI and subsequent SR or LT for HCC were retrospectively included between January 2019 and December 2020. The sensitivity and specificity of LI-RADS LR-5 for HCC were compared between the two groups using generalized estimating equations. The accuracy of patient allocation according to the Milan criteria was calculated for the LT group. Univariable and multivariable logistic regression analyses were performed to determine significant clinical factors associated with the sensitivity of LI-RADS.
Of the 281 patients, 237 were assigned to the SR group, and 44 were assigned to the LT group. The LT group showed significantly lower per-patient (48.5% vs. 79.6%, p < .001) and per-lesion sensitivity (31.0% vs. 75.9%, p < .001) than the SR group, whereas no significant difference in both per-patient (100.0% vs. 91.7%, p > .99) and per-lesion specificities (100.0% vs. 94.1%, p > .99). The accuracy of patient allocation was 50.0%. Sensitivity was significantly lower in patients with a smaller lesion size (p < .001), a larger lesion number (p = .002), and a higher Child-Pugh score (p = .009).
LI-RADS v2018 on gadoxetic acid-enhanced MRI might be insufficient in liver transplant candidates and other diagnostic imaging tests should be considered in patients with these significant clinical factors.
In liver transplant candidates with a smaller lesion size, a larger lesion number, and a higher Child-Pugh score, imaging tests other than gadoxetic acid-enhanced MRI may be clinically useful to determine the transplant eligibility.
• The sensitivity of the Liver Imaging Reporting and Data System (LI-RADS) was lower in liver transplant candidates than in those who underwent surgical resection. • With the use of gadoxetic acid-enhanced MRI, the accuracy of patient allocation for liver transplantation on the basis of the Milan criteria was suboptimal. • The sensitivity of LI-RADS v2018 was significantly associated with lesion size, lesion number, and Child-Pugh classification.
评估钆塞酸增强 MRI 上肝脏成像报告和数据系统（LI-RADS）版本 2018 用于检测肝细胞癌（HCC）的诊断性能，比较肝移植候选者（LT 组）与接受手术切除（SR 组）的患者，并确定 LI-RADS v2018 诊断性能的显著临床因素。
回顾性纳入 2019 年 1 月至 2020 年 12 月期间接受钆塞酸增强 MRI 检查并随后接受 HCC 手术切除或肝移植的患者。使用广义估计方程比较两组 LI-RADS LR-5 对 HCC 的敏感性和特异性。计算 LT 组米兰标准患者分配的准确性。进行单变量和多变量逻辑回归分析，以确定与 LI-RADS 敏感性相关的显著临床因素。
在 281 名患者中，237 名患者被分配到 SR 组，44 名患者被分配到 LT 组。LT 组的每位患者（48.5%比 79.6%，p<0.001）和每个病变的敏感性（31.0%比 75.9%，p<0.001）明显低于 SR 组，而每位患者（100.0%比 91.7%，p>0.99）和每个病变的特异性（100.0%比 94.1%，p>0.99）无显著差异。患者分配的准确性为 50.0%。病变较小（p<0.001）、病变数量较大（p=0.002）和 Child-Pugh 评分较高（p=0.009）的患者敏感性明显较低。
在肝移植候选者中，钆塞酸增强 MRI 的 LI-RADS v2018 可能不足，对于这些具有显著临床特征的患者，应考虑其他诊断性影像学检查。
在具有较小病变大小、较大病变数量和较高 Child-Pugh 评分的肝移植候选者中，除了钆塞酸增强 MRI 以外的影像学检查可能在确定移植资格方面具有临床意义。
在肝移植候选者中，LI-RADS 的敏感性低于接受手术切除的患者。
使用钆塞酸增强 MRI，基于米兰标准的肝移植患者分配的准确性不理想。
LI-RADS v2018 的敏感性与病变大小、病变数量和 Child-Pugh 分类显著相关。
