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Impact of Different Degrees of Liver Iron Concentration on MRI Feature Assessment and LI-RADS v2018 Category
Sue Cao1, Li Jianwen1, Xiaorui Su2
1Department of Radiology, The Third Afliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Background:
Hepatocellular carcinoma (HCC) in high-risk patients can be diagnosed by imaging alone, avoiding biopsy. However, whether liver iron concentration (LIC) affects MRI diagnostic performance remains uncertain.
Purpose:
To investigate the impact of different degrees of LIC on MRI feature assessment and LI-RADS v2018 category assignment in high-risk HCC patients.
Study Type:
Retrospective.
Population:
One hundred sixty-three consecutive HCC patients (mean age, 55.73 ± 9.65 years; 152 male) with 167 lesions.
Field Strength/Sequence:
3.0 T. Protocol followed LI-RADS with extra sequences (R2*, PDFF). Contrast agents included gadoxetate disodium (49 lesions), gadobenate dimeglumine (114 lesions), and Magnevist (4 lesions).
Assessment:
According to hepatic R2* values, patients were divided into three groups: non-iron overload (80 lesions), mild (54 lesions), and moderate-to-extreme (33 lesions). Three observers independently evaluated LI-RADS v2018 major, ancillary, and LR-M features, categories, and T1 signal.
Statistical Tests:
ANCOVA/Kruskal-Wallis H test, chi-square/Fisher's exact tests, and logistic regression. A two-sided p < 0.05 was considered statistically significant.
Results:
The incidences of T1 iso-/hyperintensity, nonperipheral "washout", enhancing "capsule" and HBP hypointensity differed significantly among groups. Moderate-to-severe hepatic iron overload independently influenced T1 iso-/hyperintensity (OR = 14.38 [95% CI: 4.08-50.70]) and nonperipheral "washout" (OR = 0.14 [95% CI: 0.05-0.41]). Hepatic iron overload was independently associated with enhancing "capsule" (mild: OR = 0.34 [95% CI: 0.16-0.72]); moderate-to-severe: (OR = 0.15 [95% CI: 0.06-0.37]). HBP hypointensity was influenced by Child-Pugh class B (OR = 14.51 [95% CI: 1.13-185.88]), total bilirubin (OR = 0.09 [95% CI: 0.83-0.97]), albumin (OR = 1.49 [95% CI: 1.18-1.89]), PLT (OR = 0.99 [95% CI: 0.98-1.00]) and moderate-to-severe hepatic iron overload (OR = 0.01 [95% CI: 0.00-0.25]). Proportions of LR-4 and LR-5 differed significantly among groups, and only moderate-to-severe hepatic iron overload was associated with LR-5 assignment (OR = 0.08 [95% CI: 0.02-0.28]).
Conclusion:
Hepatic iron overload, especially moderate-to-extreme, may affect the visual assessment of selected MRI features and alter LI-RADS v2018 category assignment.
Technical Efficacy Stage:
2.
