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A modified LI-RADS: targetoid tumors with enhancing capsule can be diagnosed as HCC instead of LR-M lesions

  • Gastrointestinal
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Abstract

Objective

To elucidate whether the presence of enhancing capsule can be applied to establish a modified Liver Imaging Reporting and Data System (LI-RADS) to differentiate hepatocellular carcinoma (HCC) from non-HCC malignancies in extracellular contrast agent (ECA)–enhanced and hepatobiliary agent (HBA)–enhanced MRI.

Methods

We enrolled 198 participants (161 men; mean age, 56.3 years) with chronic liver disease who underwent ECA-MRI and HBA-MRI before surgery for de novo hepatic nodule(s). Two reviewers assigned LI-RADS categories (v2018). We defined a “modified LR-5 category, which emphasizes enhancing capsule (mLR-5C)” over targetoid features and classifies tumors with both targetoid appearance and enhancing capsule as HCC instead of LR-M. We compared the diagnostic performance of conventional LI-RADS and modified LI-RADS criteria for both MRIs.

Results

A total of 258 hepatic nodules (194 HCCs, 43 benign lesions, and 21 non-HCC malignancies; median size, 19 mm) were analyzed. By conventional LI-RADS, 47 (18.2%) nodules (31 HCCs and 16 non-HCC malignancies) were categorized as LR-M. The mLR-5C criterion showed superior sensitivity (ECA-MRI, 76.6% vs. 67.0%; HBA-MRI, 60.4% vs. 56.3%; both p < 0.05) while maintaining high specificity (ECA-MRI, 93.8% vs. 98.4%; HBA-MRI, 95.3% vs. 98.4%; both p > 0.05) compared with the LR-5 criterion. Using the mLR-5C criterion, ECA-MRI exhibited higher sensitivity than HBA-MRI (76.6% vs. 60.4%, p < 0.001) and similar specificity (93.8% vs. 95.3%, p > 0.99).

Conclusion

Our modified LI-RADS achieved superior sensitivity for diagnosing HCC, without compromising specificity compared with LR-5. ECA-MRI showed higher sensitivity in diagnosing HCC than HBA-MRI by applying the mLR-5C for LR-M lesions.

Key Points

• By conventional LI-RADS, 31 (16.0%) of 194 HCCs were categorized as LR-M.

• Among 31 HCCs categorized as LR-M, 19 HCCs or 8 HCCs were recategorized as HCC on ECA-MRI or HBA-MRI, respectively, after applying the modified LR-5 category, which allocates targetoid lesions with enhancing capsule as mLR-5C instead of LR-M.

• The mLR-5C showed superior sensitivity compared with the LR-5 in both MRIs (ECA-MRI, 76.6% vs. 67.0%; HBA-MRI, 60.4% vs. 56.3%, both p < 0.05), while maintaining high specificity (ECA-MRI, 93.8% vs. 98.4%; HBA-MRI, 95.3% vs. 98.4%; both p > 0.05).

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Abbreviations

APHE:

Arterial phase hyperenhancement

cHCC-CC:

Combined hepatocellular-cholangiocarcinoma

ECA:

Extracellular contrast agent

HBA:

Hepatobiliary agent

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

IQR:

Interquartile range

LI-RADS:

Liver Imaging Reporting and Data System

TP:

Transitional phase

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The authors state that this work has not received any funding.

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Correspondence to Young Kon Kim.

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Guarantor

The scientific guarantor of this publication is Young Kon Kim in the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One (Soohyun Ahn, PhD) of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from each patient before enrollment.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Among the 198 patients, 91 (46.0%) and 122 (61.6%) have been previously reported in the prior reports from our institution. Previous studies focused on the comparison of the diagnostic performance of ECA-MRI and HBA-MRI based on LI-RADS v2017 (Hepatology. 2018 Dec;68(6):2254-2266), or the diagnostic performance of CT, ECA-MRI, and HBA-MRI alone, and in combination (Clin Gastroenterol Hepatol 2020 Aug;18(9):2091-2100). Our current study focused on the targetoid features and LR-M category of LI-RADS v2018 on each MRI. We defined a modified LR-5 category, which emphasizes enhancing capsule over targetoid features.

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• prospective

• Diagnostic study

• performed at one institution

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Min, J.H., Kim, J.M., Kim, Y.K. et al. A modified LI-RADS: targetoid tumors with enhancing capsule can be diagnosed as HCC instead of LR-M lesions. Eur Radiol 32, 912–922 (2022). https://doi.org/10.1007/s00330-021-08124-0

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  • DOI: https://doi.org/10.1007/s00330-021-08124-0

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