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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

  • Gastrointestinal
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Abstract

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.

Key Points

• LR-3 and LR-4 observations diagnosed as HCC have a significantly higher number of ancillary features favoring malignancy compared to observations proven to be benign.

• The presence of three or more ancillary features favoring malignancy has a high specificity (96.2%) for the diagnosis of HCC.

• Among all ancillary features favoring malignancy, hepatobiliary phase hypointensity yields the highest sensitivity, but also the lowest specificity for the diagnosis of HCC.

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Abbreviations

3D:

Three-dimensional

AFs:

Ancillary features

AP:

Arterial phase

APHE:

Arterial phase hyperenhancement

AUC:

Area-under-the-curve

DWI:

Diffusion-weighted images

FSE:

Fast spin echo

GRE:

Gradient-recalled echo

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

IQR:

Interquartile range

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

NPV:

Negative predictive values

OATP:

Organic anion transporting polypeptide

PPV:

Positive predictive value

PVP:

Portal venous phase

ROC:

Receiver operating characteristic

TP:

Transitional phase

VIBE:

Volumetric interpolated breath-hold examination

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Funding

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

Author information

Author notes

  1. Roberto Cannella and Federica Vernuccio contributed equally to this work.

Authors and Affiliations

  1. Section of Radiology – BiND, University Hospital “Paolo Giaccone”, Via del Vespro 127, 90127, Palermo, Italy

    Roberto Cannella & Federica Vernuccio

  2. Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Roberto Cannella, Negaur Iranpour & Alessandro Furlan

  3. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Federica Vernuccio & Daniele Marin

  4. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties) University Hospital of Palermo, Via del Vespro 127, 90127, Palermo, Italy

    Federica Vernuccio

  5. Department of Radiology, Hospital of University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 190104, USA

    Hersh Sagreiya

  6. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Kingshuk Roy Choudhury

Authors
  1. Roberto Cannella
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Corresponding author

Correspondence to Alessandro Furlan.

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Guarantor

The scientific guarantor of this publication is Alessandro Furlan.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Daniele Marin: research support from Siemens Healthineers; and Alessandro Furlan: royalties from Elsevier/Amirsys and consultant for Bracco.

Statistics and biometry

Two of the authors (Hersh Sagreiya and Kingshuk Roy Choudhury) have significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

We would like to specify that 104/155 patients were included in a previous study (title: LI-RADS: diagnostic performance of hepatobiliary phase hypointensity and major imaging features of LR-3 and LR-4 lesions measuring 10–19 mm with arterial phase hyperenhancement) where we reported the diagnostic performance of the HBP hypointensity and major features in LR-3 and LR-4 observations with APHE measuring 10–19 mm and classified according to LI-RADS v2017. Conversely, in this study, we aim at investigating the diagnostic performance of all AFs favoring malignancy, not only HBP hypointensity, for the diagnosis of HCC using the LI-RADS v2018.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Multicenter study

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Cannella, R., Vernuccio, F., Sagreiya, H. et al. 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. Eur Radiol 30, 3770–3781 (2020). https://doi.org/10.1007/s00330-020-06698-9

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