Liver Imaging Reporting and Data System (LI-RADS) v2018: diagnostic value of ancillary features favoring malignancy in hypervascular observations ≥ 10 mm at intermediate (LR-3) and high probability (LR-4) for hepatocellular carcinoma

被引:31
作者
Cannella, Roberto [1 ,2 ]
Vernuccio, Federica [1 ,3 ,4 ]
Sagreiya, Hersh [5 ]
Choudhury, Kingshuk Roy [6 ]
Iranpour, Negaur [2 ]
Marin, Daniele [3 ]
Furlan, Alessandro [2 ]
机构
[1] Univ Hosp Paolo Giaccone, Sect Radiol, BiND, Via Vespro 127, I-90127 Palermo, Italy
[2] Univ Pittsburgh, Dept Radiol, Sch Med, 200 Lothrop St, Pittsburgh, PA 15213 USA
[3] Duke Univ, Med Ctr, Dept Radiol, Durham, NC 27710 USA
[4] Univ Hosp Palermo, Dept Hlth Promot Mother & Child Care, Internal Med & Med Specialties, Via Vespro 127, I-90127 Palermo, Italy
[5] Hosp Univ Penn, Dept Radiol, 3400 Spruce St, Philadelphia, PA 19010 USA
[6] Duke Univ, Med Ctr, Dept Biostat & Bioinformat, Durham, NC USA
关键词
Liver; Cirrhosis; Hepatocellular carcinoma; Magnetic resonance imaging; ACID-ENHANCED MRI; CATEGORY; 4; CT; PERFORMANCE; OUTCOMES; NODULES;
D O I
10.1007/s00330-020-06698-9
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Objective This study was conducted in order to assess the diagnostic accuracy of LI-RADS v2018 ancillary features (AFs) favoring malignancy applied to LR-3 and LR-4 observations on gadoxetate-enhanced MRI. Methods In this retrospective dual-institution study, we included consecutive patients at high risk for hepatocellular carcinoma (HCC) imaged with gadoxetate disodium-enhanced MRI between 2009 and 2014 fulfilling the following criteria: (i) at least one LR-3 or LR-4 observation >= 10 mm; (ii) nonrim arterial phase hyperenhancement; and (iii) confirmation of benignity or malignancy by pathology or imaging follow-up. We compared the distribution of AFs between HCCs and benign observations and the diagnostic performance for the diagnosis of HCC using univariate and multivariate analyses. Significance was set at p value < 0.05. Results Two hundred five observations were selected in 155 patients (108 M, 47 F) including 167 (81.5%) LR-3 and 38 (18.5%) LR-4. There were 126 (61.5%) HCCs and 79 (28.5%) benign lesions. A significantly larger number of AFs favoring malignancy were found in LR-3 and LR-4 lesions that progressed to HCC compared to benign lesions (p < 0.001 and p = 0.003, respectively). The most common AFs favoring malignancy in HCCs were hepatobiliary phase (HBP) hypointensity (p < 0.001), transitional phase hypointensity (p < 0.001), and mild-moderate T2 hyperintensity (p < 0.001). Sensitivity and specificity of AFs for the diagnosis of HCC ranged 0.8-76.2% and 86.1-100%, respectively. HBP hypointensity yielded the highest sensitivity but also the lowest specificity and was the only AF remaining independently associated with the diagnosis of HCC at multivariate logistic regression analysis (OR 14.83, 95% CI 5.81-42.76, p < 0.001). Conclusions Among all AFs, HBP hypointensity yields the highest sensitivity for the diagnosis of HCC.
引用
收藏
页码:3770 / 3781
页数:12
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