Objectives

The aim of this study was to evaluate the diagnostic performance of introducing diffusion-weighted imaging (DWI) as a major feature to extracellular agent (ECA)-MRI for diagnosing HCC in comparison with gadoxetic acid (hepatobiliary agent, HBA)-MRI using Liver Imaging Reporting and Data System (LI-RADS) v2018.

Methods

This was a prospective intra-individual comparison study using two different types of contrast agents for liver MRI conducted at a tertiary referral academic center. One hundred forty-seven observations in 122 patients at high risk for HCC scheduled for liver surgery were included. The sensitivity, specificity, and accuracy of LI-RADS category 5 (LR-5) for HCC diagnosis according to conventional and modified LI-RADS on ECA- and HBA-MRI were measured and compared. Modified LI-RADS incorporated hyperintensity on DWI as a major feature with ECA-MRI, and hypointensity on transitional phase (TP) and/or hepatobiliary phase (HBP) as washout appearance on HBA-MRI, respectively.

Results

Modified LI-RADS on ECA-MRI had higher sensitivity and accuracy than modified LI-RADS on HBA-MRI (90.3% vs. 74.9%, p < 0.001; and 91.9% vs. 76.9%, p < 0.001, respectively), as well as higher specificity, although the difference did not reach statistical significance (96.0% vs. 88.0%, p = 0.157). The specificity of modified LI-RADS ECA-MRI was slightly lower than both conventional criteria but without a significant difference (96.0% vs. 100%, p = 0.317).

Conclusions

Using DWI findings as a major feature for modified LR-5 on ECA-MRI showed better sensitivity and accuracy than modified LR-5 on HBA-MRI, without significantly compromising specificity compared with conventional LR-5 on ECA- or HBA-MRI.

Key Points

• Prospective intra-individual comparison study using two different types of contrast agents, extracellular agent (ECA) and gadoxetic acid (hepatobiliary agent, HBA), for liver MRI was conducted.

• Applying diffusion restriction of a hepatic observation on ECA-MRI as a major feature of LI-RADS v2018 resulted in higher sensitivity and accuracy of LR-5 observations for HCC diagnosis than conventional LI-RADS v2018, and even compared to modified LI-RADS using modified washout on HBA-MRI.

• Despite increase in sensitivity and accuracy of LR-5 observations on modified LI-RADS on ECA-MRI, the specificity was not significantly different compared with conventional LI-RADS.

中文翻译：

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弥散加权成像的细胞外对比增强MRI用于HCC诊断：使用LI-RADS与gadoxetic acid进行前瞻性比较。

目标

这项研究的目的是评估将扩散加权成像（DWI）作为细胞外药物（ECA）-MRI的主要特征与使用牛肝酸（肝胆病药物，HBA）-MRI相比诊断HCC的诊断性能影像报告和数据系统（LI-RADS）v2018。

方法

这是一项前瞻性个体内比较研究，该研究使用三种不同类型的肝脏MRI造影剂在三级转诊学术中心进行。在计划进行肝脏手术的122例高危肝癌患者中，有147项观察结果包括在内。测量并比较了根据常规和改进的LI-RADS在ECA和HBA-MRI上对LI-RADS 5类（LR-5）进行HCC诊断的敏感性，特异性和准确性。改良的LI-RADS结合了DWI的高强度作为ECA-MRI的主要特征，而过渡期（TP）和/或肝胆期（HBP）的低强度分别作为HBA-MRI的洗脱表现。

结果

与在HBA-MRI上修改的LI-RADS相比，在ECA-MRI上修改的LI-RADS具有更高的灵敏度和准确性（分别为90.3％对74.9％，p  <0.001；和91.9％对76.9％，p  <0.001），以及更高的特异性，尽管差异未达到统计学显着性（96.0％对88.0％，p  = 0.157）。改良的LI-RADS ECA-MRI的特异性略低于两个常规标准，但无显着差异（96.0％对100％，p  = 0.317）。

结论

使用DWI的发现作为ECA-MRI上改良的LR-5的主要特征显示出比HBA-MRI上改良的LR-5更好的灵敏度和准确性，而与ECA-或HBA-MRI上的传统LR-5相比，其特异性没有明显降低。

关键点

•进行了前瞻性个体内比较研究，使用两种不同类型的造影剂，细胞外剂（ECA）和gadoxetic acid（肝胆道剂，HBA）进行肝脏MRI检查。

•通过对ECA-MRI进行肝脏观察的扩散限制作为LI-RADS v2018的主要特征，与常规LI-RADS v2018相比，甚至与改良的LI-RADS相比，LR-5观察结果对HCC诊断的敏感性和准确性更高在HBA-MRI上使用改良的冲洗。

•尽管在ECA-MRI上对改良的LI-RADS进行LR-5观察的敏感性和准确性有所提高，但与传统LI-RADS相比，特异性没有显着差异。