Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?

Abstract

BACKGROUNDThe Liver Imaging Reporting and Data System (LI-RADS), supported by the American College of Radiology (ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma (HCC). Diffusion-weighted imaging (DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging (MRI) for HCC.AIMTo determine whether the use of DWI can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODSIn this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity (SE), specificity (SP), accuracy (AC), positive predictive value (PPV), and negative predictive value (NPV) of LI-RADS were calculated. Youden index values were used to compare the diagnostic performance of LI-RADS with or without DWI.RESULTSAlmost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS (kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and 71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and 75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR- 4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%, 75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSIONLI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.

Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

“…In that study, five of 10 studies had only used pathology as the reference standard, which might have led to verification bias and overestimation of the probability of HCC for LR‐2 5 . In our meta‐analysis using CT/MRI LI‐RADS v2017, only one of six studies that reported the proportion of HCC for LR‐2 used pathology 13 and the other five studies used pathology and CCRS as the reference standard 12,16,18,21,24 . In addition, the definition of the LR‐2 distinctive nodule without malignant features (solid nodule <20 mm distinctive in imaging appearance compared to background nodules and with no major feature of HCC, no feature of LR‐M, and no ancillary feature of malignancy) was clearer in CT/MRI LI‐RADS v2017 4 compared to the LR‐2 cirrhosis‐associated nodule in LI‐RADS v2014, 29 which may refine the LR‐2 category so that it achieves ≤5% probability of HCC.…”

Clinical Application of Liver Imaging Reporting and Data System for Characterizing Liver Neoplasms: A Meta-Analysis

“…The flow diagram of the study selection is shown in Figure 1 and the details of excluded studies are given in Supplementary Table S3 . Among 39 studies, nine records [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] demonstrated the accuracy for HCC diagnosis of CEUS LR5, and 31 [ 20 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] evaluated that of CT/MRI LR5, while eight records [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ,…”

“…The flow diagram of the study selection is shown in Figure 1 and the details of excluded studies are given in Supplementary Table S3. Among 39 studies, nine records [20][21][22][23][24][25][26][27][28] demonstrated the accuracy for HCC diagnosis of CEUS LR5, and 31 [20, evaluated that of CT/MRI LR5, while eight records [21][22][23][24][25][26][27][28] evaluated the performance of CEUS LRM for characterizing OM and 19 reported [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] that of CT/MRI LRM.…”

Alternative approach of hepatocellular carcinoma surveillance: abbreviated MRI

“…Inclusion of diffusion weighted imaging (DWI) increases sensitivity [39][40][41] by detecting lesions based on restricted diffusion, which is thought to reflect hypercellularity. Some DWI features may also be used to help differentiate HCC from non-HCC malignancy, such as intrahepatic cholangiocarcinoma (iCCA), which often has a more targetoid appearance [42,43] .…”

“…Centers that elect to apply HBP-AMRI need to be aware of this potential pitfall and understand that HBP-AMRI will detect some patients with HCC precursor nodules prior to overt malignant transformation. Conversely, some reports have shown that occasionally HCCs can be iso- or hyperintense on HBP imaging and may be mistaken for benign lesions [ 15 , 23 , 40 ] .…”