Evaluation of LI-RADS 3 category by magnetic resonance in US-detected nodules ≤ 2 cm in cirrhotic patients.
Cirrhosis
Diagnosis
Hepatocellular carcinoma
Sensitivity and specificity
Ultrasonography
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
05
05
2020
accepted:
03
11
2020
revised:
15
09
2020
pubmed:
8
1
2021
medline:
24
6
2021
entrez:
7
1
2021
Statut:
ppublish
Résumé
Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) diagnosis in high-risk patients is a dynamic system, which was lastly updated in 2018. We aimed to evaluate the accuracy for HCC diagnosis of LI-RADS v2018 with magnetic resonance imaging (MRI) with extracellular contrast for solitary nodules ≤ 20 mm detected during ultrasound (US) surveillance in cirrhotic patients, with particular interest in those observations categorized as LI-RADS 3. Between November 2003 and February 2017, we included 262 consecutive cirrhotic patients with a newly US-detected solitary ≤ 20-mm nodule. A LI-RADS (LR) v2018 category was retrospectively assigned. The diagnostic accuracy for each LR category was described, and the main MRI findings associated with HCC diagnosis were analyzed. Final diagnoses were as follows: 197 HCC (75.2%), 5 cholangiocarcinoma (1.9%), 2 metastasis (0.8%), and 58 benign lesions (22.1%); 0/15 (0%) LR-1, 6/26 (23.1%) LR-2, 51/74 (68.9%) LR-3, 11/12 (91.7%) LR-4, 126/127 (99.2%) LR-5, and 3/8 (37.5%) LR-M were HCC. LR-5 category displayed a sensitivity and specificity of 64% (95% CI, 56.8-70.7) and 98.5% (95% CI, 91.7-100), respectively. Considering also LR-4 as diagnostic for HCC, the sensitivity slightly increased to 69.5% (95% CI, 62.6-75.9) with minor impact on specificity (96.2%; 95% CI, 89.3-99.6). Regarding LR-3 observations, 51 out of 74 were HCC, 2 were non-HCC malignancies, and 20 out of 21 LR-3 nodules > 15 mm (95.2%) were finally categorized as HCC. The high probability of HCC in US-detected LR-3 observations (68.9%) justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage. • In cirrhotic patients with nodules ≤ 20 mm detected during US surveillance, 51 out of 74 (68.9%) of LR-3 nodules by MRI corresponded to an HCC. • In LR-3 nodules, HCC diagnosis was closely related to baseline tumor size. All 5 nodules smaller than 1 cm were diagnosed as benign. Oppositely, 20 out of 21 LR-3 observations > 15 mm (95.2%) were diagnosed as HCC. • The high probability of HCC in US-detected LR-3 observations justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage.
Identifiants
pubmed: 33409789
doi: 10.1007/s00330-020-07457-6
pii: 10.1007/s00330-020-07457-6
doi:
Substances chimiques
Contrast Media
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4794-4803Subventions
Organisme : ISCIII
ID : PI18/00542
Références
Alazawi W, Cunningham M, Dearden J, Foster GR (2010) Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection. Aliment Pharmacol Ther 32:344–355. APT4370. https://doi.org/10.1111/j.1365-2036.2010.04370.x
doi: 10.1111/j.1365-2036.2010.04370.x
pubmed: 20497143
Galle PR, Forner A, Llovet JM et al (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236. https://doi.org/10.1016/j.jhep.2018.03.019
doi: 10.1016/j.jhep.2018.03.019
Heimbach JK, Kulik LM, Finn RS et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67:358–380. https://doi.org/10.1002/hep.29086
doi: 10.1002/hep.29086
pubmed: 28130846
Elsayes KM, Kielar AZ, Agrons MM et al (2017) Liver Imaging Reporting and Data System: an expert consensus statement. J Hepatocell Carcinoma 4:29–39. https://doi.org/10.2147/JHC.S125396
doi: 10.2147/JHC.S125396
pubmed: 28255543
pmcid: 5322844
Darnell A, Forner A, Rimola J et al (2015) Liver Imaging Reporting and Data System with MR imaging: evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275:698–707. https://doi.org/10.1148/radiol.15141132
doi: 10.1148/radiol.15141132
pubmed: 25658038
Choi J-Y, Cho HC, Sun M et al (2013) Indeterminate observations (liver imaging reporting and data system category 3) on MRI in the cirrhotic liver: fate and clinical implications. AJR Am J Roentgenol 201:993–1001. https://doi.org/10.2214/AJR.12.10007
doi: 10.2214/AJR.12.10007
pubmed: 24147469
Tanabe M, Kanki A, Wolfson T et al (2016) Imaging Outcomes of Liver Imaging Reporting and Data System version 2014 category 2, 3, and 4 observations detected at CT and MR imaging. Radiology 281:129–139. https://doi.org/10.1148/radiol.2016152173
doi: 10.1148/radiol.2016152173
pubmed: 27115054
pmcid: 27115054
Liu W, Qin J, Guo R et al (2018) Accuracy of the diagnostic evaluation of hepatocellular carcinoma with LI-RADS. Acta Radiol 59:140–146. https://doi.org/10.1177/0284185117716700
doi: 10.1177/0284185117716700
pubmed: 28648125
Kierans AS, Makkar J, Guniganti P et al (2018) Validation of Liver Imaging Reporting and Data System 2017 (LI-RADS) criteria for imaging diagnosis of hepatocellular carcinoma. J Magn Reson Imaging. https://doi.org/10.1002/jmri.26329
American College of Radiology. Liver Imaging Reporting and Data System version 2018. Accessed March 12 2020, from https://www.acr.org/-/media/ACR/Files/RADS/LI-RADS/LI-RADS-2018-Core.pdf?la=en
Chernyak V, Fowler KJ, Kamaya A et al (2018) Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology 289:816–830. https://doi.org/10.1148/radiol.2018181494
doi: 10.1148/radiol.2018181494
pubmed: 30251931
Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104. https://doi.org/10.1002/hep.21966
doi: 10.1002/hep.21966
pubmed: 18069697
Khalili KT, Kim TK, Jang HJ et al (2011) Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma: an analysis of diagnostic performance and resource utilization. J Hepatol 54:723–728. https://doi.org/10.1016/j.jhep.2010.07.025
doi: 10.1016/j.jhep.2010.07.025
pubmed: 21156219
Sangiovanni A, Manini MA, Iavarone M et al (2010) The diagnostic and economic impact of contrast imaging technique in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 59:638–644. https://doi.org/10.1136/gut.2009.187286
International Consensus Group for Hepatocellular NeoplasiaThe International Consensus Group for Hepatocellular Neoplasia (2009) Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 49:658–664. https://doi.org/10.1002/hep.22709
doi: 10.1002/hep.22709
Abd Alkhalik Basha M, Abd El Aziz El Sammak D, El Sammak AA (2017) Diagnostic efficacy of the Liver Imaging-Reporting and Data System (LI-RADS) with CT imaging in categorising small nodules (10–20 mm) detected in the cirrhotic liver at screening ultrasound. Clin Radiol 72:901.e1–901.e11. https://doi.org/10.1016/j.crad.2017.05.019
doi: 10.1016/j.crad.2017.05.019
Basha MAA, AlAzzazy MZ, Ahmed AF et al (2018) Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study. Eur Radiol 28:2592–2603. https://doi.org/10.1007/s00330-017-5232-y
doi: 10.1007/s00330-017-5232-y
pubmed: 29368164
van der Pol CB, Lim CS, Sirlin CB et al (2019) Accuracy of the Liver Imaging Reporting and Data System in computed tomography and magnetic resonance image analysis of hepatocellular carcinoma or overall malignancy—a systematic review. Gastroenterology 156:976–986. https://doi.org/10.1053/j.gastro.2018.11.020
doi: 10.1053/j.gastro.2018.11.020
pubmed: 30445016
Willatt JM, Hussain HK, Adusumilli S, Marrero JA (2008) MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330
doi: 10.1148/radiol.2472061331
Khan AS, Hussain HK, Johnson TD et al (2010) Value of delayed hypointensity and delayed enhancing rim in magnetic resonance imaging diagnosis of small hepatocellular carcinoma in the cirrhotic liver. J Magn Reson Imaging 32:360–366. https://doi.org/10.1002/jmri.22271
doi: 10.1002/jmri.22271
pubmed: 20677263
Kim TK, Lee KH, Jang HJ et al (2011) Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma. Radiology 259:730–738. https://doi.org/10.1148/radiol.11101549
Roskams T, Kojiro M (2010) Pathology of early hepatocellular carcinoma: conventional and molecular diagnosis. Semin Liver Dis 30:17–25. https://doi.org/10.1055/s-0030-1247129
doi: 10.1055/s-0030-1247129
pubmed: 20175030
Bruix J, Ayuso C (2019) Diagnosis of hepatic nodules in patients at risk for hepatocellular carcinoma: LIRADS probability vs certainty. Gastroenterology 156:860–862. https://doi.org/10.1053/j.gastro.2019.02.008
doi: 10.1053/j.gastro.2019.02.008
pubmed: 30776351
Kielar AZ, Chernyak V, Bashir MR et al (2019) An update for LI-RADS: version 2018. Why so soon after version 2017? J Magn Reson Imaging 50:1990–1991. https://doi.org/10.1002/jmri.26715
doi: 10.1002/jmri.26715
pubmed: 30864185
Leoni S, Piscaglia F, Golfieri R et al (2010) The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria. Am J Gastroenterol 105:599–609. https://doi.org/10.1038/ajg.2009.654
Kim SE, Lee HC, Shim JH et al (2011) Noninvasive diagnostic criteria for hepatocellular carcinoma in hepatic masses larger than 2 cm in a hepatitis B virus-endemic area. Liver Int 31:1468–1476. https://doi.org/10.1111/j.1478-3231.2011.02529.x
doi: 10.1111/j.1478-3231.2011.02529.x
pubmed: 21745284
Erkan B, Meier J, Clark TJ et al (2019) Non-invasive diagnostic criteria of hepatocellular carcinoma: comparison of diagnostic accuracy of updated LI-RADS with clinical practice guidelines of OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLSCG-NCC. PLoS One 14:e0226291. https://doi.org/10.1371/journal.pone.0226291
doi: 10.1371/journal.pone.0226291
pubmed: 31821360
Davenport MS, Khalatbari S, Liu PSC et al (2014) Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging. Radiology 272:132–142. https://doi.org/10.1148/radiol.14131963
doi: 10.1148/radiol.14131963
pubmed: 24555636
Cerny M, Chernyak V, Olivié D et al (2018) LI-RADS version 2018 ancillary features at MRI. Radiographics 38:1973–2001. https://doi.org/10.1148/rg.2018180052
doi: 10.1148/rg.2018180052
pubmed: 30289735
Kang JH, Choi SH, Byun JH et al (2020) Ancillary features in the Liver Imaging Reporting and Data System: how to improve diagnosis of hepatocellular carcinoma ≤ 3 cm on magnetic resonance imaging. Eur Radiol. https://doi.org/10.1007/s00330-019-06645-3