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Differentiation of hepatocellular carcinoma from intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in high-risk patients matched to MR field strength: diagnostic performance of LI-RADS version 2018

  • Hepatobiliary
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Abstract

Purpose

To eliminate the effects of field strength in determining the diagnostic performance of the LI-RADS version 2018 (LI-RADS v2018) in differentiating hepatocellular carcinoma (HCC) from non-HCC primary liver malignancy in high-risk patients.

Methods

Patients who were pathologically confirmed intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellular-cholangiocarcinoma (cHCC-CCA) were retrospectively reviewed. Patients with HCC were matched to the iCCA or cHCC-CCA patients on age, tumor size, MR scanner, and number of tumors. Two readers independently evaluated the lesions according to LI-RADS v2018. Diagnostic performance of LI-RADS v2018 in differentiating HCC from non-HCC primary liver malignancy were analyzed.

Results

A total of 198 patients with 204 lesions (102 HCCs, 78 iCCAs, and 24 cHCC-CCAs) were enrolled. The sensitivity and specificity of LR-5 or LR-TIV (definitely due to HCC) in diagnosing HCC were 68.63% and 85.29%, respectively. LR-M or LR-TIV (may be due to non-HCC malignancy) had a sensitivity of 72.55% and a specificity of 86.27% in diagnosing non-HCC malignancy. The sensitivity of LR-M or LR-TIV (may be due to non-HCC malignancy) for iCCA and cHCC-CCA was 82.05% and 41.67%, respectively. Nearly half (11/24, 45.83%) of cHCC-CCAs were categorized as LR-5. Three tesla MR showed higher sensitivity than 1.5 T in diagnosing HCC (80.00% vs 57.69%, P = 0.015).

Conclusion

When the effect of field strength was eliminated, LI-RADS v2018 demonstrated high specificity but suboptimal sensitivity in distinguishing HCC from non-HCC primary liver carcinomas. Most iCCAs were categorized as LR-M or LR-TIV (may be due to non-HCC malignancy). However, nearly half of cHCC-CCAs were assigned as LR-5.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

HCC:

Hepatocellular carcinoma

iCCA:

Intrahepatic cholangiocarcinoma

cHCC-CCA:

Combined hepatocellular-cholangiocarcinoma

LI-RADS:

Liver imaging reporting and data system

APHE:

Arterial phase hyperenhancement

LR-4:

Probably HCC

LR-5:

Definitely HCC

LR-M:

Probably or definitely malignant, not HCC specific

LR-TIV:

Malignancy with tumor in vein

AASLD:

American Association for the Study of Liver Disease

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Funding

This work was supported by the grants from National Natural Science Foundation of China (NSFC) No. 82071890, 81701657, 81801695 and 81771801.

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Authors and Affiliations

  1. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China

    Xianlun Zou, Yan Luo, Xuemei Hu, Yaqi Shen & Daoyu Hu

  2. Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA

    John N. Morelli

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  1. Xianlun Zou
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All authors helped to write the manuscript, edit it, and approve it for submission.

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Correspondence to Yaqi Shen.

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This retrospective study was approved by the Ethics Committee of Tongji Hospital.

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Zou, X., Luo, Y., Morelli, J.N. et al. Differentiation of hepatocellular carcinoma from intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in high-risk patients matched to MR field strength: diagnostic performance of LI-RADS version 2018. Abdom Radiol 46, 3168–3178 (2021). https://doi.org/10.1007/s00261-021-02996-y

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