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[Analysis of the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 for intrahepatic
1Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research of Zhejiang Province, Department of Radiology, Central Hospital of Lishui City, Lishui 323000, China.
Insights
The Liver Imaging Reporting and Data System (LI-RADS) version 2018 shows high specificity for diagnosing small hepatocellular carcinoma (HCC) and other liver lesions. While LR-5 criteria offer high specificity for HCC, LR-1/2 and LR-M criteria are effective for benign and other malignant lesions.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Context:
- Hepatocellular carcinoma (HCC) diagnosis in high-risk patients relies on accurate imaging.
- Small intrahepatic lesions (≤3.0 cm) pose diagnostic challenges.
- The Liver Imaging Reporting and Data System (LI-RADS) version 2018 is a standardized approach for liver lesion characterization.
Purpose:
- To evaluate the diagnostic performance of LI-RADS v2018 for small intrahepatic lesions in high-risk HCC patients.
- To compare the sensitivity and specificity of various LI-RADS categories (LR-M, LR-5, stringent LR-5) against pathological diagnosis.
- To assess the utility of LI-RADS v2018 in differentiating HCC from benign and other malignant hepatic lesions.
Summary:
- LI-RADS v2018 demonstrated high diagnostic specificity for small intrahepatic lesions (≤3.0 cm).
- The stringent LR-5 criteria showed high specificity for HCC diagnosis (96.2%), while LR-1/2 criteria were highly specific for benign lesions (100%).
- LR-M criteria exhibited good specificity (88.2%) for other malignant tumors, and LR-3 lesions were more likely benign.
Impact:
- Provides crucial data on the diagnostic accuracy of LI-RADS v2018 for small liver lesions.
- Informs clinical decision-making for managing high-risk HCC patients.
- Highlights the effectiveness of specific LI-RADS categories in differentiating various intrahepatic pathologies.
Abstract:
Objective: To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma (HCC) patients with intrahepatic parenchymal substantial lesions ≤3.0 cm. Methods: A retrospective analysis was conducted in hospitals between September 2014 to April 2020. 131 pathologically confirmed non-HCC cases with lesions ≤3.0 cm in diameter were randomly matched with 131 cases with lesions ≤3.0 cm in diameter and divided into benign (56 cases), other hepatic malignant tumor (OM, 75 cases), and HCC group (131 cases) in a 1:1 ratio. MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria (tie-break rule was applied to lesions with both HCC and LR-M features). Taking the pathological results as the gold standard, the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria (with three main signs of HCC at the same time) were calculated for HCC, OM or benign lesions diagnosis. Mann -Whitney U test was used to compare the classification results. Results: The number of cases classified as LR-M, LR-1, LR-2, LR-3, LR-4, and LR-5 in HCC group after applying the tie-break rule were 14, 0, 0, 12, 28, and 77, respectively. There were 40, 0, 0, 4, 17, 14 and 8, 5, 1, 26, 13, 3 cases in benign and OM group, respectively. There were 41 (41/77), 4 (4/14) and 1 (1/3) lesion case in the HCC, OM and benign group, respectively, that met the more stringent LR-5 criteria. The sensitivity of LR-4 combined with LR-5 (LR-4/5) criteria, LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2% (105/131), 58.8% (77/131) and 31.3% (41/131), respectively, and the specificity were 64.1% (84/131), 87.0% (114/131) and 96.2% (126/131), respectively. The sensitivity and specificity of LR-M were 53.3% (40/75) and 88.2% (165/187), respectively. The sensitivity and specificity using LR-1 combined with LR-2 (LR-1/2) criteria for the diagnosis of benign liver lesions were 10.7% (6/56) and 100% (206/206), respectively. Conclusions: LR-1/2, LR-5, and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of ≤3.0 cm. Lesions classified as LR-3 are more likely to be benign. The specificity of LR-4/5 criteria is low, while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.
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