LI-RADS Version 2018 Ancillary Features at MRI

Cerny, Milena; Chernyak, Victoria; Olivié, Damien; Billiard, J.S.; Murphy-Lavallée, Jessica; Kielar, Ania Z.; Elsayes, Khaled M.; Bourque, Laurence; Hooker, Jonathan; Sirlin, Claude B.; Tang, An

doi:10.1148/rg.2018180052

Cited by 98 publications

(70 citation statements)

References 130 publications

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“…Though obvious benign masses as seen on US were initially excluded from the cohort, there were still 64 LR‐2 observations because arterioportal shunts accounted for the majority of the LR‐2 observations (75%, 48 of 64) that were downgraded from LR‐3 in the presence of HBP isointensity. On the other hand, in agreement with previous findings that approximately 63% of LR‐4 observations were upgraded from LR‐3, we found that 108 of 176 (61.4%) LR‐4 nodules were modified from LR‐3. Among the AFs, HBP hypointensity was highly sensitive for per‐lesion detection because it can be easily discernible against a significantly enhanced background parenchyma.…”

Section: Discussionsupporting

confidence: 93%

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

Wang¹,

Yang²,

Zhu

et al. 2020

Liver Transpl

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Small recurrent hepatocellular carcinoma (HCC) can show atypical imaging patterns, and a specific diagnostic algorithm for HCC is lacking. This study aimed to better characterize postoperative recurrent HCCs <20 mm in size with gadoxetic acid-enhanced magnetic resonance imaging (MRI). We evaluated 373 newly developed nodules after hepatectomy in 204 HCC patients with chronic hepatitis B virus infection. The diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) version 2018 was calculated with gadoxetic acid-enhanced MRI to characterize recurrent HCC. Modified diagnostic algorithms were proposed by combining significant imaging biomarkers related to subcentimeter and 10-19 mm recurrence, and the algorithms were then compared with the LI-RADS system. A total of 256 recurrent HCCs (108 recurrent HCCs <10 mm in size; 148 recurrent HCCs 10-19 mm in size) were confirmed via histology or follow-up imaging. Nonrim arterial phase hyperenhancement (APHE) and 3 LI-RADS ancillary features (AFs; hepatobiliary phase hypointensity, mildmoderate T 2 hyperintensity, and restricted diffusion) were significantly related to recurrent HCCs <20 mm in size according to a multivariate analysis. For subcentimeter recurrence, combining at least 2 of the 3 AFs only achieved better specificity (sensitivity, 83.3%; specificity, 87.7%) than the LR-4 category (sensitivity, 88.9%, P = 0.21; specificity, 70.8%, P = 0.006). For 10-19 mm recurrences, combining nonrim APHE and at least 1 of the 3 AFs achieved only a significantly enhanced sensitivity of 85.1% but a lower specificity of 86.5% compared with the LR-5 category (sensitivity: 63.5%, P < 0.001; specificity: 94.2%, P = 0.13). In conclusion, the diagnostic algorithms for subcentimeter and 10-19 mm recurrent HCCs should be stratified. Combining at least 2 AFs demonstrated comparable sensitivity with significantly enhanced specificity compared with the LR-4 category for characterizing subcentimeter recurrence. Liver Transplantation 26 751-763 2020 AASLD.Recurrence of hepatocellular carcinoma (HCC) after hepatectomy is a common issue that occurs in more than 70% of patients at 5 years. (1,2) Dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are commonly performed to establish further evaluation of indeterminate observations. Repeated hepatic resection, liver transplantation, and thermal ablation are recommended for treating recurrent HCCs. (3,4) In particular, percutaneous ultrasound (US)/MRI fusion-guided thermal ablation are safe and effective treatment modalities for subcentimeter recurrent HCC. (5) Indeterminate nodules <20 mm in size are probably benign in screening populations Wang et al.

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Section: Discussionsupporting

confidence: 93%

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

Wang¹,

Yang²,

Zhu

et al. 2020

Liver Transpl

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“…In our study we reported that the hyperintense inner nodule showed APHE in 71%, and its appearance predated that of Liver Imaging Reporting and Data System (LI-RADS) major imaging features [16]. These results support the inclusion of the nodule-in-nodule architecture as an ancillary feature favouring HCC in particular, that may be applied to upgrade LR-3 observation into LR-4 [27].…”

Section: Discussionsupporting

confidence: 62%

Hyperintense nodule-in-nodule on hepatobiliary phase arising within hypovascular hypointense nodule: Outcome and rate of hypervascular transformation

Cannella

Calandra

Cabibbo

et al. 2019

European Journal of Radiology

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To investigate the clinical implications and natural history of observations showing a "nodule-in-nodule" architecture on hepatobiliary phase (HBP) in a cirrhotic population. Method: This is an IRB-approved retrospective study conducted in a single institution. We identified 20 patients (11 men and 9 women, mean age 71 years, range 51-83 years) who had a hyperintense nodule on HBP arising within a larger HBP-hypointense nodule without arterial phase hyperenhancement (APHE) at gadoxetate disodium-enhanced MRI. Size and signal intensity of the nodules were evaluated in all sequences, along with the evolution of the nodules at serial MRI studies. Results: Twenty-four nodules were analyzed in 20 patients. Mean diameter of the inner hyperintense nodule on HBP was 1.1 cm (range 0.6-1.8 cm) and that of the outer hypovascular hypointense nodule was 2.1 cm (range 1.2-4.1 cm). All intranodular foci were hyperintense on HBP and showed a typical pattern for hepatocellular carcinoma (HCC) with APHE and washout on portal venous phase (PVP) (n = 11, 46%), washout only (n = 7, 29%) or APHE with no washout (n = 6, 25%). The hyperintensity on 3-, 5-and 10-minute phases was seen in 21%, 58% and 83% of the nodules, respectively. In twelve out of sixteen (75%) nodules with subsequent imaging available the hyperintensity on HBP occurred before either the appearance of APHE or washout on PVP. Conclusions: HBP-hypointense nodules without APHE may contain a hyperintense smaller nodule-in-nodule on HBP that can precede the appearance of either APHE or washout on PVP.

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“…The liver congestion makes the interpretation of nodular vascular enhancement difficult. For diagnosis of hepatocellular carcinoma, the imaging criteria proposed in the Liver Imaging Reporting and Data System (LIRADS) are less reliable [ 55 , 63 ]. Therefore, contrary to recommendations in adults with nodules suspicious for malignancy, biopsy is suggested in Fontan patients to verify the diagnosis [ 7 , 55 ].…”

Section: Fontan-associated Liver Diseasementioning

confidence: 99%

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Lange

2020

Pediatr Radiol

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The Fontan operation is performed for various cardiac lesions with single-ventricle physiology. The survival rate of Fontan patients is increasing for adolescents and young adults, with an expected 30-year survival of >80%. Medical health care providers including specialists in organ systems and pediatric radiologists need to improve their knowledge about the Fontan circulation and the various organ complications to monitor care. In this review the author explains the basic anatomical and functional features of Fontan palliation and gives an overview of the multiple long-term organ complications that might present in the pediatric population. These include decreased physical capacity, ventricular dysfunction, atrioventricular valve regurgitation and arrhythmia, as well as protein-losing enteropathy, plastic bronchitis, growth/bone composition disturbances, renal dysfunction, and the recently recognized and important liver fibrosis (Fontan-associated liver disease). Neuropsychological and behavioral deficits occur frequently. This review focuses on the key role of radiology in making the diagnosis of these complications, monitoring therapy and predicting outcomes in the pediatric age group. The author discusses how and when radiology is important in Fontan patients, as well as how new techniques enabling quantitative measures in imaging with US, MRI and CT are adapted for pediatric use, and how they contribute to urgently needed surveillance strategies. Electronic supplementary material The online version of this article (10.1007/s00247-020-04682-5) contains supplementary material, which is available to authorized users.

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LI-RADS Version 2018 Ancillary Features at MRI

Cited by 98 publications

References 130 publications

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

Hyperintense nodule-in-nodule on hepatobiliary phase arising within hypovascular hypointense nodule: Outcome and rate of hypervascular transformation

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

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