Huang Runqian, Zheng Chunling, Xu Guixiao, Chen Xuanwei, Shen Jingxian, Mao Siyue
Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
J Hepatocell Carcinoma. 2024 Apr 26;11:775-786. doi: 10.2147/JHC.S448257. eCollection 2024.
To identify imaging features that help distinguish between HCCs and non-HCC malignancies assigned to LI-RADS M (LR-M) and evaluate the diagnostic performance of a LI-RADS with targetoid criteria using thin-rim arterial phase hyperenhancement (APHE).
This retrospective study included 381 patients (387 observations) at high-risk for HCC who underwent enhanced-MRI before surgery. Three radiologists reviewed images for LI-RADS categorization of hepatic observations. Univariate and multivariate analysis was conducted to determine reliable features to differentiate between HCC and non-HCC malignancies among the LR-M lesions. The thin-rim (<30%) APHE was defined based on the thickest thickness of rim APHE compared with the tumor radius, and a modified LI-RADS emphasizing thin-rim APHE as a specific feature of LR-M was established. We compared the diagnostic performance of modified LR-M and LI-RADS 5 (LR-5) with the conventional one.
Thin-rim APHE and targetoid diffusion-weighted imaging (DWI) were found as independent predictive factors of non-HCC malignancies, while enhancing capsule, thick-rim APHE and peripheral washout were noted as independent variables significantly associated with HCC of LR-M (<0.05). The noticeable diagnostic performance of thin-rim APHE in distinguishing non-HCC malignancies from HCCs using the ROC curve. Emphasizing thin-rim APHE on targetoid features, the modified LR-M revealed significantly superior specificity and accuracy (89.4% vs 81.1%, =0.004; and 87.9% vs 82.2%, =0.027, respectively) while maintaining high sensitivity (82.2% vs 86.0%; =0.529) compared with the LR-M. Meanwhile, the modified LR-5 achieved greater sensitivity and accuracy (88.6% vs 79.7%, =0.004; and 85.8% vs 80.1%, =0.036, respectively) for diagnosing HCC, without compromising specificity (78.3% vs.81.1%; =0.608) compared with the LR-5.
Thin-rim APHE may be the specific imaging feature for differentiating non-HCC malignancies from HCCs within LR-M. The modified targetoid criteria emphasizing thin-rim APHE can improve the diagnostic performance of LI-RADS for hepatic malignancies.
识别有助于区分肝细胞癌（HCC）与归类为肝脏影像报告和数据系统M类（LI-RADS M，LR-M）的非HCC恶性肿瘤的影像特征，并评估采用薄环动脉期高增强（APHE）的类靶征标准的LI-RADS的诊断性能。
这项回顾性研究纳入了381例HCC高危患者（387次观察），这些患者在手术前行增强MRI检查。三名放射科医生对肝脏观察结果进行LI-RADS分类的图像进行审查。进行单因素和多因素分析以确定在LR-M病变中区分HCC与非HCC恶性肿瘤的可靠特征。薄环（<30%）APHE是根据环APHE的最厚厚度与肿瘤半径的比较来定义的，并建立了一种强调薄环APHE作为LR-M特定特征的改良LI-RADS。我们将改良的LR-M和LI-RADS 5（LR-5）与传统的诊断性能进行了比较。
薄环APHE和类靶征扩散加权成像（DWI）被发现是非HCC恶性肿瘤的独立预测因素，而强化包膜、厚环APHE和周边廓清被视为与LR-M的HCC显著相关的独立变量（<0.05）。使用ROC曲线，薄环APHE在区分非HCC恶性肿瘤与HCC方面具有显著的诊断性能。强调类靶征特征上的薄环APHE，改良的LR-M显示出显著更高的特异性和准确性（分别为89.4%对81.1%，=0.004；以及87.9%对82.2%，=0.027），同时与LR-M相比保持了较高的敏感性（82.2%对86.0%；=0.529）。同时，改良的LR-5在诊断HCC方面实现了更高的敏感性和准确性（分别为88.6%对79.7%，=0.004；以及85.8%对80.1%，=0.036），与LR-5相比不影响特异性（78.3%对81.1%；=0.608）。
薄环APHE可能是在LR-M范围内区分非HCC恶性肿瘤与HCC的特定影像特征。强调薄环APHE的改良类靶征标准可提高LI-RADS对肝脏恶性肿瘤的诊断性能。
