Progression Rates of LR-2 and LR-3 Observations on MRI to Higher LI-RADS Categories in Patients at High Risk of Hepatocellular Carcinoma: A Retrospective Study

Ranathunga, Damithri S; Osman, Hussein Al; Islam, Nasir; McInnes, Matthew D. F.; Munir, Javeria; Pol, Christian B. van der; Elfaal, Mohamed Walaaeldin; Walsh, Cynthia

doi:10.2214/ajr.21.26376

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…[ 20 ] Two of the patient‐level studies relied on imaging reports, with Ranathunga et al being the only study to independently review imaging studies. [ 21 ] The study by Ranathunga and colleagues was also the only study to perform patient‐level analysis using LI‐RADS Version 2018 and reported 11.1% of 36 patients developed HCC during the mean follow‐up 17.8‐month study period. [ 21 ] Across all three studies, the proportion of patients who developed HCC ranged from 11.1% to 24.5%, and an additional 8%–22.2% developed an LR‐4 observation during the median follow‐up of 9–17.9 months.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 13 eligible studies, including 11 full texts and two abstracts. [15][16][17][18][19][20][21][22][23][24][25][26][27] Four studies exclusively evaluated LR-3 observations, one evaluated LR-4 observations, and the remaining eight evaluated both LR-3 and LR-4 observations (Figure 1). Characteristics of studies are detailed in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review

et al. 2022

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Patients with indeterminate liver nodules, classified as LR-3 and LR-4 observations per the Liver Imaging Reporting and Data System, are at risk of developing hepatocellular carcinoma (HCC), but risk estimates remain imprecise. We conducted a systematic review of Ovid MEDLINE, EMBASE, and Cochrane databases from inception to December 2021 to identify cohort studies examining HCC incidence among patients with LR-3 or LR-4 observations on computed tomography (CT) or magnetic resonance imaging (MRI).Predictors of HCC were abstracted from each study, when available. Of 13 total studies, nine conducted LR-3 observation-level analyses, with the proportions of incident HCC ranging from 1.2% to 12.5% at 12 months and 4.2% to 44.4% during longer study follow-up. Among three studies with patientlevel analyses, 8%-22.2% of patients with LR-3 lesions developed LR-4 observations and 11.1%-24.5% developed HCC. Among nine studies conducting LR-4 observation-level analyses, incident HCC ranged from 30.8% to 44.0% at 12 months and 30.9% to 71.0% during study follow-up; conversely, 6%-42% of observations were downgraded to LR-3 or lower. Patient-level factors associated with HCC included older age, male sex, higher alphafetoprotein levels, viral etiology, and prior history of HCC; observation-level factors included maximum diameter, threshold growth, T2 hyperintensity, and visibility on ultrasound. Studies were limited by small sample sizes, inclusion of patients with prior HCC, short follow-up duration, and failure to account for clustering of observations in patients or competing risks of transplantation and death. LR-3 and LR-4 observations have elevated but variable risks of

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review

et al. 2022

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“…In clinical practice, an increasing number of subcentimeter size hypervascular observations are observed on contrast-enhanced computed tomography (CECT) and magnetic resonance (MR) imaging (MRI) studies, with the cumulative risk of HCC progression in these observations being higher than in hypovascular nodules. 7,8 Ranathunga et al 9 showed that the rate of progression from LR-3 to LR-4 was 22.22% (►Fig. 2A-F) and from LR-3 to LR-5 was 11.1% at least 12 months after the initial observation was detected.…”

Section: Lr-3mentioning

confidence: 99%

The Gray Zone: LR3, LR-M, and LR-TIV

Ganesan

Jalkote

Nellore

2023

Journal of Gastrointestinal and Abdominal Radiology

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The goal of Liver Imaging Reporting and Data System (LI-RADS) is to standardize the lexicon, imaging techniques, interpretation, and reporting of observations in patients with a potential risk for developing hepatocellular carcinoma (HCC), and, consequently, improve communication between radiologists and physicians. LI-RADS diagnostic algorithms are applied to a population “at risk,” follow a stepwise algorithmic approach which categorize and stratify individual observations as HCC, and also assess the likelihood of non-HCC malignancies and tumor in vein. Risk factors for developing HCC have geographical variations, which significantly impact diagnostic and management strategies; however, these variations are not considered in the LIRADS v2018 version. Further, the diagnostic algorithm includes several major and ancillary features, and, tie-breaking rules, which result in numerous probable combinations by which a plausible observation could be assigned a particular category, inherently increasing its complexity. Heterogeneity of the diagnostic algorithm results in certain imaging pitfalls and poses challenges in the precise characterization of observations, complicating its use in routine clinical practice. This article reviews the gray zones which may be encountered in the evaluation of LR-3, LR-M, and LR-TIV observations during routine clinical imaging with contrast-enhanced computed tomography and magnetic resonance imaging.

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“…According to LI-RADS v2018, repeat or alternative diagnostic imaging within 3-6 months is recommended for LR-3 observations [6,9]. However, previous longitudinal studies have shown a wide variation in the progression rate from LR-3 to higher categories, ranging from 6-55.6% [10][11][12][13][14][15][16][17][18][19][20]. This variability poses challenges for standardized monitoring strategies for both radiologists and referring clinicians, as it creates uncertainty regarding the rate of malignancy associated with LR-3 observations and their progression.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome of indeterminate hepatocellular observations (LI-RADS 3) of ＜2 cm based on gadoxetic acid-enhanced MRI

Xing¹,

Zhu

et al. 2023

Preprint

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Objectives: To determine long-term outcomes and predictors of progression of indeterminate hepatocellular observation (LR-3) of <2 cm to higher categories in high-risk patients based on serial gadoxetic acid-enhanced MRI (Gd-EOB-MRI) examinations. Methods: A retrospective review was conducted on 125 patients with hepatitis B virus (HBV)-related cirrhosis who underwent Gd-EOB-MRI examinations at baseline and during follow-up. A total of 149 untreated LR-3 observations (<2 cm) were included in the study. The Cox proportional hazards model was employed to perform a multivariate analysis of the risk factors for predictive progression of hepatocellular observations (upgraded to LR-4 or LR-5), which included patient demographics and LI-RADS imaging features. Additionally, the Kaplan–Meier method was utilized to assess the overall cumulative incidence curve for progression. Finally, the log-rank test was used to compare the cumulative incidence curves between cases with and without significant predictive risk factors. Results: During a median follow-up interval of 18.3 months, the overall cumulative incidence of progression for LR-3 observations was 41.6%. The specific progression rates were 1.3%, 9.5%, 17.3%, and 37.3% at 3, 6, 12, and 24 months, respectively. The multivariate analysis revealed three significant independent predictors of progression: non-rim arterial phase hyperenhancement (APHE) (hazard ratio [HR] = 2.19, 95% CI = 1.27–3.79; P = 0.005), subthreshold growth (HR = 2.78, 95% CI = 1.48–5.23; P = 0.001), and mild-moderate T2 hyperintensity (HR = 5.25, 95% CI = 2.05–13.43; P < 0.001). LR-3 observations exhibiting non-rim APHE or mild-moderate T2 hyperintensity demonstrated a significantly higher cumulative risk of progression and a shorter median follow-up time to upgrade compared to those without these features (53.3% vs. 33.7%, 14.7 months vs. 18.9 months, both P <0.001; 50.0% vs. 28.8%, 15.1 months vs. 26.5 months, both P <0.001, respectively). Conclusions: In cases of LR-3 observations (<2 cm), the presence of non-rim APHE, subthreshold growth, and mild-to-moderate T2 hyperintensities were found to be associated with a significantly higher risk of progression. LR-3 observations exhibiting non-rim APHE or mild-to-moderate T2 hyperintensity were specifically associated with a higher cumulative risk of progression and a shorter median follow-up time to upgrade.

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Progression Rates of LR-2 and LR-3 Observations on MRI to Higher LI-RADS Categories in Patients at High Risk of Hepatocellular Carcinoma: A Retrospective Study

Cited by 7 publications

References 18 publications

Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review

Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review

The Gray Zone: LR3, LR-M, and LR-TIV

Long-term outcome of indeterminate hepatocellular observations (LI-RADS 3) of ＜2 cm based on gadoxetic acid-enhanced MRI

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