Choi Se Jin, Shin Jeong In, Kim Pyeong Hwa, Park Hyo Jung, Kim Seonok, Jung Ah Young, Cho Young Ah, Lee Jin Seong, Song In Hye, Gang Sujin, Namgoong Jung-Man, Koh Kyung-Nam, Yoon Hee Mang
Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea.
Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11775-y.
To evaluate LI-RADS major and ancillary features for MRI-based diagnosis of pediatric malignant liver tumors.
This single-center retrospective study enrolled pediatric patients who underwent contrast-enhanced liver MRI for focal liver lesions from January 2010-February 2023. Three readers independently performed imaging analysis based on LI-RADS v2018. The reference standard was a pathological diagnosis or stability/regression for over one year on follow-up. Estimation of diagnostic accuracy and multivariable logistic regression were conducted to identify LI-RADS features associated with malignant hepatocellular tumors and hepatic malignancy in general.
Of the 102 patients (median age [interquartile range], 4.5 [0.6-14.0] years; boys:girls, 54:48), 58.8% (60/102) had malignant liver tumors and 49.0% (50/102) had malignant hepatocellular tumors. The sensitivity and specificity of major features for diagnosis of malignant hepatocellular tumors were as follows: nonrim arterial enhancement, 73.4% and 39.6%; enhancing capsule, 56.7% and 92.0%; nonperipheral washout, 70.1% and 94.2%. Nonperipheral washout (sensitivity, 70.1%; specificity, 94.2%; adjusted OR, 34.5; p < 0.001), restricted diffusion (sensitivity, 97.9%; specificity, 53.8%; adjusted OR, 72.3; p = 0.001), and fat-in-mass (sensitivity, 29.0%; specificity, 93.0%; adjusted OR, 4.3; p = 0.01) were associated with malignant hepatocellular tumors, while nonperipheral washout (sensitivity, 58.7%; specificity, 94.5%; adjusted OR, 12.5; p < 0.001), restricted diffusion (sensitivity, 97.1%; specificity, 65.8%; adjusted OR, 31.1; p < 0.001), and mosaic architecture (sensitivity, 79.5%; specificity, 90.0%; adjusted OR, 20.4; p < 0.001) were associated with hepatic malignancy in general.
Restricted diffusion was a sensitive MRI LI-RADS feature, while nonperipheral washout and mosaic architecture were specific features for diagnosing pediatric malignant liver tumors.
Questions MRI is the recommended modality for pediatric focal liver lesions, but only a few studies have examined the diagnostic accuracy of MRI LI-RADS features in children. Findings Restricted diffusion was sensitive for malignant liver tumors, while mosaic architectures were specific for malignant liver tumors. Nonperipheral washout was specific for diagnosing malignant hepatocellular tumors. Clinical relevance Nonperipheral washout, restricted diffusion, and mosaic architecture were reliable MRI LI-RADS features for diagnosing pediatric malignant liver tumors.
评估基于磁共振成像（MRI）的肝脏影像报告和数据系统（LI-RADS）主要及辅助特征在小儿恶性肝肿瘤诊断中的应用。
本单中心回顾性研究纳入了2010年1月至2023年2月期间因肝脏局灶性病变接受肝脏增强MRI检查的小儿患者。三位阅片者根据LI-RADS v2018独立进行影像分析。参考标准为病理诊断或随访一年以上病情稳定/好转。进行诊断准确性评估和多变量逻辑回归分析，以确定与恶性肝细胞肿瘤及总体肝脏恶性肿瘤相关的LI-RADS特征。
102例患者（中位年龄[四分位间距]，4.5[0.6 - 14.0]岁；男:女，54:48）中，58.8%（60/102）患有恶性肝肿瘤，49.0%（50/102）患有恶性肝细胞肿瘤。主要特征对恶性肝细胞肿瘤诊断的敏感性和特异性如下：非边缘动脉强化，73.4%和39.6%；强化包膜，56.7%和92.0%；非周边廓清，70.1%和94.2%。非周边廓清（敏感性，70.1%；特异性，94.2%；校正比值比，34.5；p < 0.001）、扩散受限（敏感性，97.9%；特异性，53.8%；校正比值比，72.3；p = 0.001）和肿块内脂肪（敏感性，29.0%；特异性，93.0%；校正比值比，4.3；p = 0.01）与恶性肝细胞肿瘤相关，而非周边廓清（敏感性，58.7%；特异性，94.5%；校正比值比，12.5；p < 0.001）、扩散受限（敏感性，97.1%；特异性，65.8%；校正比值比，31.1；p < 0.001）和马赛克结构（敏感性，79.5%；特异性，90.0%；校正比值比，20.4；p < 0.001）总体上与肝脏恶性肿瘤相关。
扩散受限是MRI的一个敏感的LI-RADS特征，而非周边廓清和马赛克结构是诊断小儿恶性肝肿瘤的特异性特征。
问题MRI是小儿肝脏局灶性病变的推荐检查方式，但仅有少数研究探讨了MRI LI-RADS特征在儿童中的诊断准确性。发现扩散受限对恶性肝肿瘤敏感，而马赛克结构对恶性肝肿瘤具有特异性。非周边廓清对诊断恶性肝细胞肿瘤具有特异性。临床意义非周边廓清、扩散受限和马赛克结构是诊断小儿恶性肝肿瘤可靠的MRI LI-RADS特征。
