Validation of the Liver Imaging Reporting and Data System Treatment Response Criteria After Thermal Ablation for Hepatocellular Carcinoma

被引:33
作者
Cools, Katherine S. [1 ]
Moon, Andrew M. [2 ]
Burke, Lauren M. B. [3 ]
McGinty, Katrina A. [3 ]
Strassle, Paula D. [1 ,4 ]
Gerber, David A. [1 ,5 ]
机构
[1] Univ N Carolina, Sch Med, Dept Surg, 4025 Burnett Womack Bldg,Campus Box 7211, Chapel Hill, NC 27599 USA
[2] Univ N Carolina, Sch Med, Div Gastroenterol, Chapel Hill, NC 27599 USA
[3] Univ N Carolina, Sch Med, Dept Radiol, Chapel Hill, NC 27599 USA
[4] Univ N Carolina, Sch Publ Hlth, Dept Epidemiol, Chapel Hill, NC 27599 USA
[5] Univ N Carolina, Lineberger Canc Ctr, Chapel Hill, NC 27599 USA
基金
美国国家卫生研究院;
关键词
RADIOFREQUENCY ABLATION; LOCOREGIONAL THERAPY; LI-RADS; TRANSARTERIAL CHEMOEMBOLIZATION; CIRRHOTIC-PATIENTS; PATHOLOGICAL RESPONSE; ETHANOL INJECTION; MODIFIED RECIST; TUMOR RESPONSE; TRANSPLANTATION;
D O I
10.1002/lt.25673
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Single hepatocellular carcinoma (HCC) tumors can be successfully eradicated with thermal ablation (TA). We assessed the validity of the Liver Imaging Reporting and Data System Treatment Response (LR-TR) criteria with a retrospective analysis of a single-center database of patients with small HCC tumors (<3 cm in diameter) who underwent both laparoscopic TA and liver transplantation (LT) from 2004 to 2018. Postablation MRIs were assigned LR-TR categories (nonviable, equivocal, and viable) for ablated lesions and Liver Imaging Reporting and Data System (LI-RADS) categories (probable or definite HCC) for untreated lesions. Interpretations were compared with the histopathology of the post-LT explanted liver. There were 45 patients with 81 tumors (59 ablated and 22 untreated; mean size, 2.2 cm), and 23 (39%) of the ablated tumors had viable HCC on histopathology. The sensitivity/specificity of LR-TR categories (nonviable/equivocal versus viable) of ablated tumors was 30%/99%, with a positive predictive value (PPV)/negative predictive value (NPV) of 93%/69%. The sensitivity varied with residual tumor size. The sensitivity/specificity of LI-RADS 4 and 5 diagnostic criteria at detecting new HCC was 65%/94%, respectively, with a PPV/NPV of 85%/84%. The interrater reliability (IRR) was high for LR-TR categories (90% agreement, Cohen's kappa = 0.75) and for LI-RADS LR-4 and LR-5 diagnostic categories (91% agreement, Cohen's kappa = 0.80). In patients with HCC <3 cm in diameter, LR-TR criteria after TA had high IRR but low sensitivity, suggesting that the LR-TR categories are precise but inaccurate. The low sensitivity may be secondary to TA's disruption in the local blood flow of the tissue, which could affect the arterial enhancement phase on MRI. Additional investigation and new technologies may be necessary to improve imaging after ablation.
引用
收藏
页码:203 / 214
页数:12
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