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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.

Publication ,  Journal Article
Cannella, R; Vernuccio, F; Sagreiya, H; Choudhury, KR; Iranpour, N; Marin, D; Furlan, A
Published in: Eur Radiol
July 2020

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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Published In

Eur Radiol

DOI

EISSN

1432-1084

Publication Date

July 2020

Volume

30

Issue

7

Start / End Page

3770 / 3781

Location

Germany

Related Subject Headings

  • Retrospective Studies
  • Research Design
  • Reproducibility of Results
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Liver Neoplasms
  • Humans
  • Gadolinium DTPA
 

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Cannella, R., Vernuccio, F., Sagreiya, H., Choudhury, K. R., Iranpour, N., Marin, D., & Furlan, A. (2020). 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(7), 3770–3781. https://doi.org/10.1007/s00330-020-06698-9
Cannella, Roberto, Federica Vernuccio, Hersh Sagreiya, Kingshuk Roy Choudhury, Negaur Iranpour, Daniele Marin, and Alessandro Furlan. “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, no. 7 (July 2020): 3770–81. https://doi.org/10.1007/s00330-020-06698-9.
Journal cover image

Published In

Eur Radiol

DOI

EISSN

1432-1084

Publication Date

July 2020

Volume

30

Issue

7

Start / End Page

3770 / 3781

Location

Germany

Related Subject Headings

  • Retrospective Studies
  • Research Design
  • Reproducibility of Results
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Liver Neoplasms
  • Humans
  • Gadolinium DTPA