Kim Seong Uk, Hwang Jeong Ah, Han Seungchul, Lee Jeong Hyun, Choi Seo-Youn, Ha Sang Yun
Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur Radiol. 2025 Feb 6. doi: 10.1007/s00330-025-11407-5.
To propose a simplified diagnostic approach for mucinous cystic neoplasm (MCN) of the liver and compare its diagnostic performance with the European Association for the Study of the Liver (EASL) criteria.
We conducted a retrospective cohort study of 124 patients with pathologically confirmed lesions (13 MCNs, 111 hepatic cysts) who underwent CT/MRI between January 2016 and January 2023. Two major features (thick septation, nodularity) and five minor features (upstream biliary dilatation, thin septations, internal hemorrhage, perfusion change, < 3 coexistent hepatic cysts) of the EASL criteria were evaluated. For a septa-wall relationship, the angle of indentation was measured, and the optimal angle predicting MCN was determined by receiver operating characteristic curve analysis. Logistic regression identified features predicting MCN, and a modified criteria was developed. The sensitivity, specificity, and accuracy of both criteria were compared using McNemar's test.
The optimal indentation angle was 111°. Absence of indentation or indentation at an angle > 111° (odds ratio (OR), 100.4; 95% confidence interval (CI), 4.9-2076.0) and < 3 coexistent hepatic cysts (OR, 47.8; 95% CI, 1.5-1489.1) were independent features predicting MCN. Our modified criteria used a combination of them and demonstrated greater accuracy (98.4% vs. 92.7%; p = 0.035) than the EASL criteria (a combination of ≥ 1 major and ≥ 1 minor feature[s]), with comparable sensitivity (92.3% vs. 76.9%; p = 0.317) and specificity (99.1% vs. 94.6%; p = 0.059).
Our modified criteria using two imaging features may be a promising alternative to current EASL criteria to improve accuracy in diagnosing MCN.
Question Radiological diagnosis of mucinous cystic neoplasm of the liver remains challenging due to the lack of specific imaging features, leading to suboptimal treatment decisions. Findings No external indentation or an indentation angle > 111° and fewer than 3 coexistent hepatic cysts are independent factors predicting mucinous cystic neoplasm of the liver. Clinical relevance The simplified approach using these two imaging features for diagnosing mucinous cystic neoplasm of the liver offers improved accuracy and reliability over the 2022 EASL criteria, potentially reducing misdiagnosis and unnecessary surgeries.
提出一种简化的肝脏黏液性囊性肿瘤（MCN）诊断方法，并将其诊断性能与欧洲肝脏研究协会（EASL）标准进行比较。
我们对2016年1月至2023年1月期间接受CT/MRI检查且病理确诊病变的124例患者（13例MCN，111例肝囊肿）进行了回顾性队列研究。评估了EASL标准的两个主要特征（厚分隔、结节状）和五个次要特征（上游胆管扩张、薄分隔、内部出血、灌注改变、共存肝囊肿<3个）。对于分隔与壁的关系，测量压痕角度，并通过受试者操作特征曲线分析确定预测MCN的最佳角度。逻辑回归确定预测MCN的特征，并制定了修改后的标准。使用McNemar检验比较两种标准的敏感性、特异性和准确性。
最佳压痕角度为111°。无压痕或压痕角度>111°（比值比（OR），100.4；95%置信区间（CI），4.9 - 2076.0）以及共存肝囊肿<3个（OR，47.8；95%CI，1.5 - 1489.1）是预测MCN的独立特征。我们修改后的标准将它们结合使用，与EASL标准（≥1个主要特征和≥1个次要特征的组合）相比，显示出更高的准确性（98.4%对92.7%；p = 0.035），敏感性（92.3%对76.9%；p = 0.317）和特异性（99.1%对94.6%；p = 0.059）相当。
我们使用两个影像学特征的修改后标准可能是当前EASL标准的一个有前景的替代方法，可提高MCN诊断的准确性。
问题由于缺乏特异性影像学特征，肝脏黏液性囊性肿瘤的放射学诊断仍然具有挑战性，导致治疗决策欠佳。发现无外部压痕或压痕角度>111°以及共存肝囊肿少于3个是预测肝脏黏液性囊性肿瘤的独立因素。临床意义使用这两个影像学特征诊断肝脏黏液性囊性肿瘤的简化方法比2022年EASL标准具有更高的准确性和可靠性，可能减少误诊和不必要的手术。
