Choi Se Jin, Kim Hae Young, Lee So Jung, Kim So Yeon, Won Hyung Jin, Shin Yong Moon, Choi Sang Hyun, Byun Jae Ho
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Eur Radiol. 2025 Aug 22. doi: 10.1007/s00330-025-11938-x.
We evaluated the value of EC as a major feature for hepatocellular carcinoma (HCC) and its implications on simplifying LI-RADS v2018: by either excluding EC (LI-RADS[EC(-)]), or treating EC as equivalent to other major features (LI-RADS[EC(+)]).
This retrospective study included patients who underwent preoperative MRI within 1 month of surgery. Two radiologists independently assigned LI-RADS categories, with consensus resolution. The association between EC and HCC was evaluated by diagnostic odds ratio (DOR). Sensitivity and specificity of LI-RADS[EC(-)] and LI-RADS[EC(+)] were compared to LI-RADS v2018 using generalized estimating equations.
Among 735 patients (median [interquartile range] age, 60 [54-66] years, 562 men) with 986 observations, 150 (20.4%) underwent extracellular contrast (ECA)-MRI and 585 (79.6%) underwent hepatobiliary contrast (HBA)-MRI. EC was significantly associated with HCC on both ECA-MRI (DOR = 16.6, p < 0.001) and HBA-MRI (DOR = 9.3, p < 0.001). LI-RADS[EC(+)] strategy demonstrated significantly higher sensitivity than LI-RADS v2018 on both ECA-MRI (81.3% vs. 78.4%, p = 0.047) and HBA-MRI (74.2% vs. 72.7%; p = 0.005), without significant differences in specificity (96.7% vs. 96.7%; p > 0.99 for ECA-MRI and 91.7% vs. 92.1%; p = 0.26 for HBA-MRI). However, LI-RADS[EC(-)] yielded a lower sensitivity (74.8% vs. 78.4%; p = 0.03 for ECA-MRI and 72.3% vs. 72.7%; p = 0.17 for HBA-MRI) without a gain in specificity.
EC is strongly associated with HCC and critical for maintaining the sensitivity of the LI-RADS v2018. Treating EC as equivalent to other major features may simplify LI-RADS and improve sensitivity, particularly on ECA-MRI, where the increase in sensitivity was more pronounced than on HBA-MRI.
Question Can LIRADS v2018 be simplified by considering enhancing capsule (EC) as equivalent to other major features (i.e., non-peripheral washout), regardless of observation size? Findings Treating EC as equivalent to other major features yielded higher sensitivity than LIRADS v2018 on both extracellular- and hepatobiliary contrast-enhanced MRI, without significantly compromising specificity. Clinical relevance EC is a key feature for hepatocellular carcinoma diagnosis. The strategy of treating EC as equivalent to other major features can be used to increase diagnostic sensitivity as well as simplify LI-RADS v2018, particularly on extracellular contrast-enhanced MRI.
我们评估了强化包膜（EC）作为肝细胞癌（HCC）主要特征的价值及其对简化肝脏影像报告和数据系统（LI-RADS）v2018的意义：即要么排除EC（LI-RADS[EC(-)]），要么将EC视为等同于其他主要特征（LI-RADS[EC(+)]）。
这项回顾性研究纳入了在手术前1个月内接受术前磁共振成像（MRI）检查的患者。两名放射科医生独立指定LI-RADS类别，并通过协商达成一致。采用诊断比值比（DOR）评估EC与HCC之间的关联。使用广义估计方程将LI-RADS[EC(-)]和LI-RADS[EC(+)]的敏感性和特异性与LI-RADS v2018进行比较。
在735例患者（年龄中位数[四分位间距]为60[54 - 66]岁，男性562例）的986次观察中，150例（20.4%）接受了细胞外对比剂（ECA）-MRI检查，585例（79.6%）接受了肝胆对比剂（HBA）-MRI检查。在ECA-MRI（DOR = 16.6，p < 0.001）和HBA-MRI（DOR = 9.3，p < 0.001）上，EC均与HCC显著相关。LI-RADS[EC(+)]策略在ECA-MRI（81.3%对78.4%，p = 0.047）和HBA-MRI（74.2%对72.7%；p = 0.005）上的敏感性均显著高于LI-RADS v2018，特异性无显著差异（ECA-MRI为96.7%对96.7%；p > 0.99，HBA-MRI为91.7%对92.1%；p = 0.26）。然而，LI-RADS[EC(-)]的敏感性较低（ECA-MRI为74.8%对78.4%；p = 0.03，HBA-MRI为72.3%对72.7%；p = 0.17），且特异性并未提高。
EC与HCC密切相关，对维持LI-RADS v2018的敏感性至关重要。将EC视为等同于其他主要特征可能会简化LI-RADS并提高敏感性，尤其是在ECA-MRI上，其敏感性的提高比在HBA-MRI上更为明显。
问题 将强化包膜（EC）视为等同于其他主要特征（即非周边廓清），无论观察大小如何，能否简化LI-RADS v2018？研究结果 在细胞外和肝胆对比增强MRI上，将EC视为等同于其他主要特征的策略比LI-RADS v2018具有更高的敏感性，且未显著损害特异性。临床意义 EC是肝细胞癌诊断的关键特征。将EC视为等同于其他主要特征的策略可用于提高诊断敏感性并简化LI-RADS v2018，尤其是在细胞外对比增强MRI上。
