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Comparison of the diagnostic performance of imaging criteria for HCCs ≤ 3.0 cm on gadoxetate disodium-enhanced MRI

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Abstract

Background and purpose

Imaging-based diagnostic systems play important roles in hepatocellular carcinoma (HCC). We aimed to compare the diagnostic performance of recently updated imaging criteria for HCCs ≤ 3.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging (MRI).

Methods

493 nodules (399 HCCs, 24 other malignancies, 70 benign) 1.0–3.0 cm from 400 patients, including 322 male (mean age 59.3 ± 9.4 years) and 78 female (mean age 61.2 ± 9.0 years), at risk for HCC who underwent gadoxetate disodium-enhanced MRI between July 2015 and December 2016 were retrospectively evaluated. Final diagnosis was determined histopathologically or clinically. The sensitivity and specificity in diagnosing HCC of the latest versions of four imaging criteria [Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), Korean Liver Cancer Association-National Cancer Center (KLCA-NCC)] were compared using generalized estimating equations.

Results

In 331 only pathologically diagnosed nodules, the sensitivities of both the APASL (86.8%) and KLCA-NCC criteria (85.4%) were significantly higher than the sensitivities of the EASL (71.8%) and LR-5 (71.1%) criteria (p < 0.001 for each pairwise comparison). However, the specificity of LR-5 was significantly higher than that of APASL (92.2% vs. 70.6%, respectively; p = 0.011) but did not differ significantly from the specificities of EASL (84.3%; p = 0.634) and KLCA-NCC (78.4%; p = 0.107).

Conclusion

Of the four international imaging criteria, LI-RADS and EASL showed high specificity but suboptimal sensitivity for diagnosing HCCs ≤ 3 cm. However, APASL and KLCA-NCC had a higher sensitivity but a lower specificity than LI-RADS and EASL.

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Abbreviations

HCC:

Hepatocellular carcinoma

APASL:

Asian Pacific Association for the Study of the Liver

LI-RADS:

Liver Imaging Reporting and Data System

AASLD:

American Association for the Study of Liver Disease

EASL:

European Association for the Study of the Liver

KLCA-NCC:

Korean Liver Cancer Association-National Cancer Center

TACE:

Transcatheter arterial chemoembolization

RFA:

Radiofrequency ablation

CCC:

Cholangiocarcinoma

BCLC:

Barcelona Clinic Liver Cancer

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Author notes

  1. Jieun Byun and Sang Hyun Choi contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Jieun Byun, Sang Hyun Choi, Jae Ho Byun, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin & Pyo-Nyun Kim

  2. Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea

    Jieun Byun

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Contributions

SHC and JHB contributed to study concept and design. JB and SHC acquired, analyzed, and interpreted the data. JB and SHC drafted the manuscript. JB and SHC performed statistical analysis. JHB, SJL, SYK, HJW, YMS, and PNK made critical revisions to the manuscript. JHB supervised the study.

Corresponding author

Correspondence to Jae Ho Byun.

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Conflict of interest

Jieun Byun, Sang Hyun Choi, Jae Ho Byun, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin and Pyo-Nyun Kim declare no conflicts of interest that pertain to this work.

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The study protocol was approved by the institutional review board of our center.

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The need for informed consent was waived by the institutional review board of our center.

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Byun, J., Choi, S.H., Byun, J.H. et al. Comparison of the diagnostic performance of imaging criteria for HCCs ≤ 3.0 cm on gadoxetate disodium-enhanced MRI. Hepatol Int 14, 534–543 (2020). https://doi.org/10.1007/s12072-020-10040-2

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