Department of Radiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, No. 83 Jintang Road, Hedong District, Tianjin 300170, China.
Department of Radiology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, No. 83 Jintang Road, Hedong District, Tianjin 300170, China.
Arab J Gastroenterol. 2024 Feb;25(1):58-63. doi: 10.1016/j.ajg.2023.12.012. Epub 2024 Jan 20.
The sensitivity of the Liver Imaging Reporting and Data System (LI-RADS) in the diagnosis of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) was suboptimal. This study evaluated the LI-RADS diagnostic performance in HCC when modifying the definition of washout using the transition phase (TP) or hepatobiliary phase (HBP) hypointensity on EOB-MRI.
This retrospective study included patients at high risk of HCC who underwent EOB-MRI from June 2016 to June 2021. Three modified LI-RADS (mLI-RADS) algorithms were formulated according to different definitions of washout as follows: (a) portal venous phase (PVP) or TP hypointensity, (b) PVP or HBP hypointensity, and (c) PVP or TP or HBP hypointensity. Diagnostic performance, including sensitivity, specificity, and accuracy, was compared between mLI-RADS and LI-RADS v2018 using McNemar's test.
A total of 379 patients with 426 pathologically confirmed hepatic observations (250 HCCs, 88 nonHCC malignancies, and 88 benign lesions) were included in our study. The sensitivity rates of mLI-RADS a-c (80.0 %, 80.8 %, and 80.8 %) were all higher than that of LI-RADS v2018 (74.4 %) (all p < 0.05). The specificity rates of mLI-RADS a-c (86.9 %, 85.8 %, and 85.8 %) were all slightly lower than that of LI-RADS v2018 (88.6 %), although no statistically significant difference was noted (all p > 0.05). The accuracies of the three mLI-RADS algorithms were the same and were all higher than that of LI-RADS v2018 (82.9 % vs. 80.3 %, all p < 0.05).
When the definition of washout appearance was extended to TP or HBP hypointensity on EOB-MRI, the diagnostic sensitivity of LI-RADS for HCC improved without decreasing specificity.
在钆塞酸增强磁共振成像（EOB-MRI）上，肝脏成像报告和数据系统（LI-RADS）对肝细胞癌（HCC）的诊断敏感性较差。本研究通过在 EOB-MRI 的过渡期（TP）或肝胆期（HBP）低信号中修改洗脱的定义，评估了 LI-RADS 在 HCC 中的诊断性能。
本回顾性研究纳入了 2016 年 6 月至 2021 年 6 月间在高 HCC 风险患者中接受 EOB-MRI 的患者。根据洗脱的不同定义制定了三种改良 LI-RADS（mLI-RADS）算法，如下所示：（a）门静脉期（PVP）或 TP 低信号，（b）PVP 或 HBP 低信号，和（c）PVP 或 TP 或 HBP 低信号。使用 McNemar 检验比较 mLI-RADS 和 LI-RADS v2018 之间的诊断性能，包括敏感性、特异性和准确性。
本研究共纳入 379 例患者，共 426 个经病理证实的肝脏观察结果（250 例 HCC、88 例非 HCC 恶性肿瘤和 88 例良性病变）。mLI-RADS a-c 的敏感性率（80.0%、80.8%和 80.8%）均高于 LI-RADS v2018 的敏感性率（74.4%）（均 p<0.05）。mLI-RADS a-c 的特异性率（86.9%、85.8%和 85.8%）均略低于 LI-RADS v2018 的特异性率（88.6%），但差异无统计学意义（均 p>0.05）。三种 mLI-RADS 算法的准确性相同，均高于 LI-RADS v2018（82.9% vs. 80.3%，均 p<0.05）。
在 EOB-MRI 上扩展洗脱外观的定义为 TP 或 HBP 低信号时，LI-RADS 对 HCC 的诊断敏感性提高，而特异性不变。
