P ancreatic cancer has a dismal prognosis with a 5-year survival rate of only 8% (1). However, surgical resection with a negative margin may be a potentially curative treatment option for this disease. Recently, the concept of borderline resectable pancreatic cancer has emerged to indicate a special category of potential resectability that may help refine the conventional resectable or unresectable binary stratification system (2). Although there is no widespread consensus on the ideal treatment for borderline resectable pancreatic cancer (3-5), neoadjuvant treatment has been suggested to enhance the margin-negative (ie, R0) resection rate for this disease and to enable better patient selection for surgical procedures (6). In this regard, accurate categorization of patients according to their resectability status at initial workup would have a major impact on the management decision (2,7). Furthermore, proper selection of surgical candidates would offer the best chance to cure patients with resectable disease while preventing futile laparotomies in those with unresectable diseases.The National Comprehensive Cancer Network guidelines (version 2.2017; 8) recommend pancreatic protocol multi-detector row CT, including pancreatic and portal venous phases, preferably CT angiography with thin-section axial images, multiplanar reformats, and maximal intensity projection or three-dimensional volumetric images, for the initial evaluation of patients who are clinically suspected of having pancreatic cancers. Indeed, for the prediction of the resectability of pancreatic cancer, CT shows good diagnostic performance (9-11). Currently, in an attempt to standardize the imaging interpretation of the local resectability of pancreatic cancers, several guidelines define the vessels that should be assessed and the imaging criteria to define the tumor-vascular relationship: abutment (,180°),
Background: Few studies have reported on the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) LR-5 or LR-5 V in the diagnosis of hepatocellular carcinoma (HCC) using MRI with gadoxetate disodium. Purpose: To determine the diagnostic performance of LI-RADS version 2018 (hereafter, v2018) on gadoxetate disodium-enhanced MRI in comparison with LI-RADS version 2017 (hereafter, v2017) for the diagnosis of HCC in patients with cirrhosis or chronic hepatitis B viral infection or at high risk for HCC. Materials and Methods: This retrospective study between January 2013 and October 2015 evaluated consecutive patients at high risk for HCC who had at least one observation of 10 mm or greater on gadoxetate disodium-enhanced MRI and no history of previous treatment for hepatic lesions. MRI features were reviewed by three radiologists. Observations were categorized according to LI-RADS v2018 and LI-RADS v2017. Per-observation sensitivity and specificity of LR-5 using LI-RADS v2017 and v2018 were compared using generalized estimating equation models. Results: A total of 422 observations, including 234 HCCs confirmed by results of pathologic examination in 387 patients (305 men and 82 women; mean age 6 standard deviation, 59 years 6 10), were included. In all observations, LI-RADS v2018 provided higher sensitivity than LI-RADS v2017 (81% [189 of 234] vs 68% [160 of 234], respectively; P , .001). In small observations (10-19 mm), LI-RADS v2018 yielded much higher sensitivity than LI-RADS v2017 (76% [34 of 45] vs 11% [five of 45], respectively; P , .001) with relatively little impairment of specificity (94% [121 of 128] vs 99% [127 of 128], respectively; P = .013). Conclusion: Updated LR-5 criteria of Liver Imaging Reporting and Data System (LI-RADS) version 2018 on gadoxetate disodiumenhanced MRI can improve sensitivity in the diagnosis of small hepatocellular carcinomas (10-19 mm) with only slight impairment in specificity compared with the criteria of LI-RADS version 2017.
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