Jeong Boryeong, Choi Se Jin, Choi Sang Hyun, Jang Hyeon Ji, 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, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Eur Radiol. 2024 Feb;34(2):1210-1218. doi: 10.1007/s00330-023-10092-6. Epub 2023 Aug 17.
Despite the revision of threshold growth (TG) in the Liver Imaging Reporting and Data System (LI-RADS) version 2018, the appropriate time period between the two examinations for TG has not been determined. We compared the accuracy of LI-RADS with TG based on tumor growth rate for the diagnosis of hepatocellular carcinoma (HCC) with that of LI-RADS v2018 based on the original TG.
Patients who underwent preoperative MRI for focal solid lesions (≤ 3.0 cm) were retrospectively evaluated. Three readers measured the size of each lesion on prior CT/MRI and index MRI, with tumor growth rate defined as the percent change in lesion size per month. In addition to the original TG (≥ 50% size increase within ≤ 6 months), the modified TG based on tumor growth rates ≥ 10%/month (TG-10%), ≥ 20%/month (TG-20%), and ≥ 30%/month (TG-30%) were evaluated. The accuracies of these evaluation methods for LI-RADS category 5 HCC were compared using generalized estimation equations.
A total of 508 lesions from 370 patients were evaluated. Compared with LI-RADS v2018 with the original TG, the accuracy of LI-RADS with TG-10% was significantly higher (85.0% vs. 80.7%, p < .001), whereas the accuracies of LI-RADS with TG-20% (81.3% vs. 80.7%, p = .404) and TG-30% (79.3% vs. 80.7%, p = .052) were not significant. The sensitivity of LI-RADS with TG-10% was higher than that of LI-RADS v2018 (79.0% vs. 72.5%, p < .001), whereas their specificities were not significantly different (96.6% vs. 96.6%, p > .999).
TG-10% improved the sensitivity of LI-RADS by detecting additional hepatocellular carcinomas underestimated due to short-term follow-up.
Threshold growth based on tumor growth rate can be clinically useful in the diagnosis of hepatocellular carcinoma, by improving the sensitivity of LI-RADS.
• The diagnostic accuracy of Liver Imaging Reporting and Data System (LI-RADS) v2018 was not significantly affected by the time interval between prior and index assessments of threshold growth. • In the 334 hepatocellular carcinomas, the frequency of threshold growth was significantly higher using tumor growth rate ≥ 10%/month (TG-10%) than original threshold growth (53.3% vs. 18.0%, p < .001). • Compared with LI-RADS v2018 with the original threshold growth, LI-RADS with TG-10% had significantly higher accuracy (85.0% vs. 80.7%, p < .001) and sensitivity (79.0% vs. 72.5%, p < .001) but a similar specificity (96.6% vs. 96.6%, p > .999).
尽管《肝脏影像报告和数据系统（LI-RADS）》2018版修订了阈值增长（TG），但两次检查之间适合TG的时间段尚未确定。我们将基于肿瘤生长率的LI-RADS对肝细胞癌（HCC）诊断的准确性与基于原始TG的LI-RADS v2018的准确性进行了比较。
对接受术前MRI检查的局灶性实性病变（≤3.0 cm）患者进行回顾性评估。三位阅片者测量了之前CT/MRI和索引MRI上每个病变的大小，肿瘤生长率定义为病变大小每月的变化百分比。除了原始TG（≤6个月内大小增加≥50%）外，还评估了基于肿瘤生长率≥10%/月（TG-10%）、≥20%/月（TG-20%）和≥30%/月（TG-30%）的改良TG。使用广义估计方程比较这些评估方法对LI-RADS 5类HCC的准确性。
共评估了370例患者的508个病变。与采用原始TG的LI-RADS v2018相比，采用TG-10%的LI-RADS准确性显著更高（85.0%对80.7%，p<0.001），而采用TG-20%（81.3%对80.7%，p=0.404）和TG-30%（79.3%对80.7%，p=0.052）的LI-RADS准确性无显著差异。采用TG-10%的LI-RADS敏感性高于LI-RADS v2018（79.0%对72.5%，p<0.001），而它们的特异性无显著差异（96.6%对96.6%，p>0.999）。
TG-10%通过检测因短期随访而被低估的额外肝细胞癌提高了LI-RADS的敏感性。
基于肿瘤生长率的阈值增长通过提高LI-RADS的敏感性在肝细胞癌诊断中可能具有临床实用性。
• 先前和索引阈值增长评估之间的时间间隔对《肝脏影像报告和数据系统（LI-RADS）》2018版的诊断准确性没有显著影响。• 在334例肝细胞癌中，使用肿瘤生长率≥10%/月（TG-10%）时阈值增长的频率显著高于原始阈值增长（53.3%对18.0%，p<0.001）。• 与采用原始阈值增长的LI-RADS v2018相比，采用TG-10%的LI-RADS具有显著更高的准确性（85.0%对80.7%，p<0.001）和敏感性（79.0%对72.5%，p<0.001），但特异性相似（96.6%对96.6%，p>0.999）。
