Bae Jae Seok, Lee Jeong Min, Yoon Jeong Hee, Kim Jae Hyun, Jeon Sun Kyung, Yoo Jeongin
Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Cancer Imaging. 2025 Jul 1;25(1):84. doi: 10.1186/s40644-025-00902-z.
The utility of threshold growth (TG) in hepatocellular carcinoma (HCC) imaging remains contentious across major guidelines. This study aimed to investigate the diagnostic implications of TG in HCC diagnosis using the criteria set by the Liver Imaging Reporting and Data System (LI-RADS).
In this single-center retrospective study, three radiologists independently evaluated pre-transplantation hepatobiliary agent-enhanced MR images and prior CT/MR images using LI-RADS v2018 in consecutive patients who underwent liver transplantation between January 2010 and November 2022. TG was defined as a ≥ 50% size increase in ≤ 6 months. Explanted livers served as reference standards. Frequencies of TG between HCCs and non-HCCs were compared using Fisher's exact test, and interobserver agreement was assessed using Fleiss κ statistics. The diagnostic performance of LI-RADS category 5 in the diagnosis of HCC was assessed with and without considering TG as a major feature. McNemar tests were used to compare results.
The cohort included 158 patients (mean age, 59.1 ± 7.5 years; 130 males) with 280 observations (207 HCCs, 5 non-HCC malignancies, and 68 benign lesions). TG was identified in 44 (15.7%) observations. Interobserver agreement on TG was moderate (κ = 0.280). Incorporating TG as a major feature significantly enhanced the sensitivity of LI-RADS category 5 in diagnosing HCC (33.8% vs. 40.6%, p < 0.001) without compromising specificity (100.0% vs. 94.5%, p = 0.125).
Incorporating TG as a major criterion in LI-RADS category 5 enhanced the diagnostic sensitivity for HCC in liver transplant candidates with minimal impact on specificity. However, TG demonstrated a variable interobserver agreement.
Not applicable.
在肝细胞癌（HCC）成像中，阈值生长（TG）的效用在各大指南中仍存在争议。本研究旨在使用肝脏影像报告和数据系统（LI-RADS）设定的标准，探讨TG在HCC诊断中的诊断意义。
在这项单中心回顾性研究中，三位放射科医生使用LI-RADS v2018，对2010年1月至2022年11月期间连续接受肝移植的患者的移植前肝胆剂增强磁共振成像（MR）图像和既往CT/MR图像进行独立评估。TG定义为在≤6个月内大小增加≥50%。切除的肝脏作为参考标准。使用Fisher精确检验比较HCC与非HCC之间TG的频率，并使用Fleiss κ统计量评估观察者间的一致性。在考虑和不考虑TG作为主要特征的情况下，评估LI-RADS 5类在HCC诊断中的诊断性能。使用McNemar检验比较结果。
该队列包括158例患者（平均年龄59.1±7.5岁；130例男性），共280次观察（207例HCC、5例非HCC恶性肿瘤和68例良性病变）。在44次（15.7%）观察中发现了TG。观察者间对TG的一致性为中等（κ=0.280）。将TG作为主要特征显著提高了LI-RADS 5类在诊断HCC中的敏感性（33.8%对40.6%，p<0.001），而不影响特异性（100.0%对94.5%，p=0.125）。
将TG作为LI-RADS 5类的主要标准可提高肝移植候选者中HCC的诊断敏感性，且对特异性影响最小。然而，TG显示出观察者间的一致性存在差异。
不适用。
