Diagnostic performance of LR-5 based on hypointensity on Gd-EOB-DTPA-enhanced MRI in the hepatobiliary phase for sHCC using LI-RADS v2018 criteria.

AIM

To investigate the value of the LR-5, which is based on hepatobiliary phase (HBP) hypointensity, for small hepatocellular carcinoma (sHCC) using LI-RADS v2018 criteria.

MATERIALS AND METHODS

From January 2015 to December 2021 in institution 1, and from January 2019 to February 2022 in institution 2, 239 patients at high risk for hepatocellular carcinoma (HCC) underwent contrast-enhanced MRI. Two radiologists independently evaluated the imaging features and classified them according to LI-RADS v2018 criteria, calculating the diagnostic performance of LR-5 based on consensus data. LI-RADS-m1: HBP hypointensity was used as an additional major feature along with the LI-RADS v2018. LI-RADS-m2: HBP hypointensity replaced nonperipheral "washout" in the portal venous phase. The definition of LR-DN was nodules pathologically diagnosed as high-grade dysplastic nodules (HGDN) were recategorized as LR-DN. The diagnostic performance of LR-5 was recalculated. The diagnostic performance of the LR-5 was compared using McNemar's test.

RESULTS

Using LI-RADS v2018, LI-RADS-m1, and LI-RADS-m2 criteria for LR-5, the sensitivities were 82.67%, 86.22%, and 88.44%, the specificities were 82.00%, 66.00%, and 54.00%, and the accuracies were 82.55%, 82.55%, and 82.18%, respectively. After the addition of the LR-DN, the sensitivities of LR-5 in the above diagnostic model remained unchanged, with accuracies of 84.36%, 87.27%, and 88.36% and specificities of 92.00%, 92.00%, and 88.00%, respectively.

CONCLUSIONS

HBP hypointensity may improve the sensitivity of LR-5. We attempted to propose the LR-DN, HBP hypointensity may be used as a complement to washout as an additional major feature without significantly decreasing specificity.