A modified LI-RADS: targetoid tumors with enhancing capsule can be diagnosed as HCC instead of LR-M lesions

Min, Ji Hye; Kim, Jong Man; Kim, Young Kon; Kim, Honsoul; Choi, Gyu Seong; Kang, Tae Wook; Cha, D.I.; Hwang, Jiyoung; Ko, Seong Eun; Ahn, Soohyun

doi:10.1007/s00330-021-08124-0

Cited by 8 publications

(11 citation statements)

References 27 publications

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“…Although previous studies provided data for differentiating non-HCC malignancy from atypical HCC categorized as LR-M, 6 , 17 , 21 , 22 no study has yet concentrated on revising targetoid features for the LR-M category. The present research revealed that some MRI features (as shown in Table 4 ) can be used to distinguish between HCC and non-HCC malignancy in the LR-M category.…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 16–18 However, enhancing capsule was more commonly associated with extracellular agent MRI (ECA-MRI) compared with hepatobiliary agent MRI (HBA-MRI), because of the peculiar characteristics of gadoxetic acid that could cause enhancement of the liver parenchyma. 17 , 19 Therefore, identifying other imaging features that help distinguish between non-HCC malignancies and HCCs assigned to LR-M is worth studying.…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, to date, the relevant studies have been limited. 17 , 20 Therefore, the present study aimed to identify imaging features that help distinguish between HCCs and non-HCC malignancies assigned to LR-M and to evaluate the diagnostic performance of a LI-RADS with targetoid criteria using thin-rim APHE in both ECA-MRI and HBA-MRI.…”

Section: Introductionmentioning

confidence: 99%

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A Modified Targetoid Feature Emphasizing Thin-Rim APHE to Improve the Diagnostic Performance of LI-RADS for Malignant Hepatic Tumors

Huang,

Zheng,

et al. 2024

JHC

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Objective To identify imaging features that help distinguish between HCCs and non-HCC malignancies assigned to LI-RADS M (LR-M) and evaluate the diagnostic performance of a LI-RADS with targetoid criteria using thin-rim arterial phase hyperenhancement (APHE). Materials and Methods This retrospective study included 381 patients (387 observations) at high-risk for HCC who underwent enhanced-MRI before surgery. Three radiologists reviewed images for LI-RADS categorization of hepatic observations. Univariate and multivariate analysis was conducted to determine reliable features to differentiate between HCC and non-HCC malignancies among the LR-M lesions. The thin-rim (<30%) APHE was defined based on the thickest thickness of rim APHE compared with the tumor radius, and a modified LI-RADS emphasizing thin-rim APHE as a specific feature of LR-M was established. We compared the diagnostic performance of modified LR-M and LI-RADS 5 (LR-5) with the conventional one. Results Thin-rim APHE and targetoid diffusion-weighted imaging (DWI) were found as independent predictive factors of non-HCC malignancies, while enhancing capsule, thick-rim APHE and peripheral washout were noted as independent variables significantly associated with HCC of LR-M ( P <0.05). The noticeable diagnostic performance of thin-rim APHE in distinguishing non-HCC malignancies from HCCs using the ROC curve. Emphasizing thin-rim APHE on targetoid features, the modified LR-M revealed significantly superior specificity and accuracy (89.4% vs 81.1%, P =0.004; and 87.9% vs 82.2%, P =0.027, respectively) while maintaining high sensitivity (82.2% vs 86.0%; P =0.529) compared with the LR-M. Meanwhile, the modified LR-5 achieved greater sensitivity and accuracy (88.6% vs 79.7%, P =0.004; and 85.8% vs 80.1%, P =0.036, respectively) for diagnosing HCC, without compromising specificity (78.3% vs.81.1%; P =0.608) compared with the LR-5. Conclusion Thin-rim APHE may be the specific imaging feature for differentiating non-HCC malignancies from HCCs within LR-M. The modified targetoid criteria emphasizing thin-rim APHE can improve the diagnostic performance of LI-RADS for hepatic malignancies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Modified Targetoid Feature Emphasizing Thin-Rim APHE to Improve the Diagnostic Performance of LI-RADS for Malignant Hepatic Tumors

Huang,

Zheng,

et al. 2024

JHC

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“…Identification of the aggressive HCCs during the pretherapeutic workup has strong prognostic and therapeutic implications, including cases with diagnostic difficulty. There have been several studies attempting to differentiate HCC from intrahepatic cholangiocarcinoma (ICC) in LR-M category lesions (6,(12)(13)(14), while no study focused on both LR-M and LR-3/4 lesions whose imaging features do not definitely reach the diagnoses of neither HCC nor ICC. This study demonstrates that HBP hypointensity, septum, and serum AFP >16.2 ng/mL were significant independent variables for the diagnosis of HCCs in a challenging subgroup composed of LR-3, LR-4, and LR-M category lesions.…”

Section: Discussionmentioning

confidence: 99%

LI-RADS category 3, 4, and M observations: a multiple parameters diagnostic model for hepatocellular carcinoma

Chen,

Zheng

et al. 2023

Acta Radiol

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Background Hepatic lesions categorized as LR-3, LR-4, and LR-M are challenging to accurately assess and diagnose. Purpose To combine potential clinical and/or magnetic resonance imaging (MRI) features for a more comprehensive hepatocellular carcinoma (HCC) versus non-HCC diagnosis for patients with LR-3, LR-4, and LR-M graded lesions. Methods Data were consecutively retrieved from 82 at-risk patients with LR-3 (n = 43), LR-4 (n = 20), and LR-M (n = 23) lesions. Significant findings for the differentiation of HCC and non-HCC, including MRI features and clinical factors, were identified with univariable and multivariable analyses. The variables for a prediction model were selected through stepwise use of Akaike's Information Criterion (AIC) to build multivariable logistic regression model. Results Serum alpha-fetoprotein (AFP) >16.2 ng/mL (odds ratio [OR] = 22.4; P = 0.006), septum (OR = 52.1; P = 0.011), and hepatobiliary phase (HBP) hypointensity (OR = 40.2; P = 0.001) were confirmed as independent predictors of HCC. When combining the three predictors and mild-moderate T2 hyperintensity, the model (AIC = 50.91) showed good accuracy with a C-index of 0.948. Conclusion In at-risk patients with LR-3, LR-4, or LR-M lesions, integrating AFP, septum, HBP hypointensity, and mild-moderate T2 hyperintensity achieved high diagnostic performance for the diagnosis of HCC.

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“…Rim APHE was categorized as 1) a smooth, thin rim with a thickness within 25% of the in-plane diameter of the tumor throughout the perimeter, and 2) an irregular, thick rim with a thickness partly or entirely exceeding 25% of the tumor diameter ( Figs. 2 , 3 ) [ 7 23 ]. Furthermore, corona enhancement, capsule, intralesional fat, peritumoral bile duct dilatation, non-smooth tumor margin, radiologic vascular invasion by a tumor in the vein (TIV), vascular involvement other than TIV (encasement, narrowing, tethering, occlusion, or obliteration) [ 24 ], peritumoral hypointensity on HBP, and HBP hypointense nodules without rim or nonrim APHE [ 25 ] were assessed.…”

Section: Methodsmentioning

confidence: 99%

Targetoid Primary Liver Malignancy in Chronic Liver Disease: Prediction of Postoperative Survival Using Preoperative MRI Findings and Clinical Factors

et al. 2023

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Objective We aimed to assess and validate the radiologic and clinical factors that were associated with recurrence and survival after curative surgery for heterogeneous targetoid primary liver malignancies in patients with chronic liver disease and to develop scoring systems for risk stratification. Materials and Methods This multicenter retrospective study included 197 consecutive patients with chronic liver disease who had a single targetoid primary liver malignancy (142 hepatocellular carcinomas, 37 cholangiocarcinomas, 17 combined hepatocellular carcinoma-cholangiocarcinomas, and one neuroendocrine carcinoma) identified on preoperative gadoxetic acid-enhanced MRI and subsequently surgically removed between 2010 and 2017. Of these, 120 patients constituted the development cohort, and 77 patients from separate institution served as an external validation cohort. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were identified using a Cox proportional hazards analysis, and risk scores were developed. The discriminatory power of the risk scores in the external validation cohort was evaluated using the Harrell C-index. The Kaplan–Meier curves were used to estimate RFS and OS for the different risk-score groups. Results In RFS model 1, which eliminated features exclusively accessible on the hepatobiliary phase (HBP), tumor size of 2–5 cm or > 5 cm, and thin-rim arterial phase hyperenhancement (APHE) were included. In RFS model 2, tumors with a size of > 5 cm, tumor in vein (TIV), and HBP hypointense nodules without APHE were included. The OS model included a tumor size of > 5 cm, thin-rim APHE, TIV, and tumor vascular involvement other than TIV. The risk scores of the models showed good discriminatory performance in the external validation set (C-index, 0.62–0.76). The scoring system categorized the patients into three risk groups: favorable, intermediate, and poor, each with a distinct survival outcome (all log-rank p < 0.05). Conclusion Risk scores based on rim arterial enhancement pattern, tumor size, HBP findings, and radiologic vascular invasion status may help predict postoperative RFS and OS in patients with targetoid primary liver malignancies.

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A modified LI-RADS: targetoid tumors with enhancing capsule can be diagnosed as HCC instead of LR-M lesions

Cited by 8 publications

References 27 publications

A Modified Targetoid Feature Emphasizing Thin-Rim APHE to Improve the Diagnostic Performance of LI-RADS for Malignant Hepatic Tumors

A Modified Targetoid Feature Emphasizing Thin-Rim APHE to Improve the Diagnostic Performance of LI-RADS for Malignant Hepatic Tumors

LI-RADS category 3, 4, and M observations: a multiple parameters diagnostic model for hepatocellular carcinoma

Targetoid Primary Liver Malignancy in Chronic Liver Disease: Prediction of Postoperative Survival Using Preoperative MRI Findings and Clinical Factors

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