LI-RADS for MR Imaging Diagnosis of Hepatocellular Carcinoma: Performance of Major and Ancillary Features

Abstract

Purpose To evaluate the performance of major features, ancillary features, and categories of Liver Imaging Reporting and Data System (LI-RADS) version 2014 at magnetic resonance (MR) imaging for the diagnosis of hepatocellular carcinoma (HCC). Materials and Methods This retrospective institutional review board-approved study included patients with liver MR imaging and at least one pathologically proved lesion. Between 2004 and 2016, 102 patients (275 observations including 113 HCCs) met inclusion criteria. Two radiologists independently assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS category. Per-lesion estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed by using generalized estimating equation models. Results Major features (arterial phase hyperenhancement, washout, capsule, and threshold growth) had a sensitivity of 88.5%, 60.6%, 32.9%, and 41.6%, and a specificity of 18.6%, 84.8%, 98.8%, and 83.2% for HCC, respectively. Ancillary features (mild-moderate T2 hyperintensity, restricted diffusion, mosaic architecture, intralesional fat, lesional fat sparing, blood products, and subthreshold growth) had a sensitivity of 62.2%, 54.8%, 9.9%, 30.9%, 23.1%, 2.8%, and 48.3%, and a specificity of 79.4%, 90.6%, 99.4%, 94.2%, 83.1%, 99.3%, and 91.4% for HCC, respectively. The LR-5 or LR-5 V categories had a per-lesion sensitivity of 50.8% and a specificity of 95.8% for HCC, respectively. The LR-4, LR-5, or LR-5 V categories (determined by using major features only vs combination of major and ancillary features) had a per-lesion sensitivity of 75.9% and 87.9% and a per-lesion specificity of 87.5% and 86.2%, respectively. Conclusion The use of ancillary features in combination with major features increases the sensitivity while preserving a high specificity for the diagnosis of HCC.

Validation of Liver Imaging Reporting and Data System 2017 (LI‐RADS) Criteria for Imaging Diagnosis of Hepatocellular Carcinoma

“…Our findings are in agreement with prior investigations using LI‐RADS 2014, demonstrating rates of HCC for LR5 observations of 72.6–86% and LR4 of 69–75% . 11.4–26.9% of LR3 observations in our study were HCCs, which is in agreement with a prior investigation using only an extracellular agent . In our study, HCCs categorized as LR3 were significantly larger in size than those that were non‐HCCs for two of the readers.…”

“…Darnell et al demonstrated lower sensitivity but similar specificity (42% and 98%, respectively) using extracellular agent and LR2014 criteria; however, their study included only observations ≤20 mm that were detected on antecedent screening ultrasound . An additional prior investigation using extracellular agent and LR2014 criteria demonstrated sensitivity and specificity of 50.8% and 95.8%, respectively, which is in line with our results . Although there have been prior diagnostic performance studies evaluating LI‐RADs with either an extracellular agent or gadoxetate disodium, there have been few that have included both agents within the same study design.…”

“…Furthermore, while the use of gadoxetate disodium and extracellular agents have both been incorporated into LI‐RADS criteria, comparison of the diagnostic performance of the two contrast agents has yet to be determined. The few current validation studies are limited by single‐center cohorts, lack of standardized CT and MRI parameters, evaluation of selected aspects of the diagnostic algorithm with a single contrast agent, and use of 2014 or earlier LI‐RADS criteria . Therefore, the aim of our study was to evaluate the rate, diagnostic performance, and interreader reliability (IRR) of LI‐RADS 2017 for HCC, including LR major and ancillary features, with both gadoxetate and extracellular agent‐enhanced MRI against a reference standard of histopathology or imaging follow‐up.…”

Diagnostic performance of MR for hepatocellular carcinoma based on LI‐RADS v2018, compared with v2017

“…The characteristics of the study population and risk factors for HCC are summarized in Supplemental Table 1 (online). For those diagnosed as HCC without pathology, the follow‐up imaging demonstrated substantial growth, associated with APHE, and washout or enhancing capsule . The reference standards for LR‐1, LR‐2, and LR‐3 observations were based on typical imaging findings or the absence of progression to a malignant category (LR‐4, LR‐5, or LR‐TIV) during the follow‐up period …”

MRI‐based risk factors of hepatocellular carcinoma in patients with chronic liver disease: A prospective observational study

“…Hypervascularity in the hepatic arterial phase of dynamic CT or MRI is the hallmark finding in the imaging‐based diagnosis of HCC. Generally, the diagnosis of HCC by arterial phase hyperenhancement (APHE) and washout on CT or MRI shows high specificity . However, HCC does not always show APHE, particularly in the early stage of hepatocarcinogenesis .…”