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What is the risk of HCC in hypervascular LI-RADS 3 observations without ancillary features in routine clinical
Diana Kadi1, Danielle E Kruse2, Nicole Abedrabbo3
1Department of Radiology, Duke University, Durham, USA. diana.kadi@duke.edu.
Purpose:
The Liver Imaging Reporting and Data System (LI-RADS) categorizes liver observations based on their risk for HCC, with LI-RADS 3 observations (LR-3s) having an intermediate probability. Studies have shown that approximately one-third of LR-3 observations develop into hepatocellular carcinoma (HCC), however, this is not observed in clinical practice. This study aimed to assess the HCC rate for hypervascular LR-3s.
Methods:
We retrospectively identified consecutive MRI reports from 2013 to 2018 with hypervascular LR-3s in our institutional cohort. Observations with arterial phase hyperenhancement, no additional major/ancillary features, and < 2 cm in size were included. Development of HCC was determined based on a composite reference standard similar to published meta-analysis.
Results:
129 patients (mean age 60+/-11 years, 69 [53.5%] male) with 166 LR-3s observations were included. Ten (6.5%, 95% CI [2.2-10.7%]) observations developed into HCC based on change in category to LR-5 and growth in a median of 360 days (range 90-947) after index MRI. HCC rate for LR-3 was 3.0% at 1 year (95% CI [0-6.1%]).
Conclusion:
We observed a lower rate of HCC development in small hypervascular LR-3s without any additional major/ancillary features at 1 year compared to the entire LR-3 population reported in literature.