Comparison of LI-RADS 2018 and KLCA-NCC 2018 for noninvasive diagnosis of hepatocellular carcinoma using magnetic resonance imaging

Abstract

<jats:p>Background/Aims: This study aimed to compare the diagnostic performances of Liver Imaging Reporting and Data System (LI-RADS) 2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria on magnetic resonance imaging (MRI) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.Methods: This retrospective study included 273 treatment-naïve patients (71 patients with extracellular contrast agent [ECA]-MRI and 202 patients with hepatobiliary agent [HBA]-MRI; 352 lesions including 263 HCCs) with high risk of HCC who underwent contrast-enhanced MRI between 2016 and 2017. Two readers evaluated all lesions according to the criteria of LI-RADS 2018 and KLCA-NCC 2018. The per-lesion diagnostic performances were compared using the generalized estimating equation method.Results: On ECA-MRI, the sensitivity and specificity of LI-RADS 2018 and KLCA-NCC 2018 were not significantly different (LR-5 vs. definite HCC: 75.8% vs. 69.4%, &lt;i&gt;P&lt;/i&gt;=0.095 and 95.8% vs. 95.8%, &lt;i&gt;P&lt;/i&gt;&gt;0.999; LR-5/4 vs. definite/probable HCC: 87.1% vs.83.9%, P=0.313 and 87.5% vs. 91.7%, &lt;i&gt;P&lt;/i&gt;=0.307). On HBA-MRI, definite HCC of KLCA-NCC 2018 showed significantly higher sensitivity (79.1% vs. 68.2%, &lt;i&gt;P&lt;/i&gt;&lt;0.001) than LR-5 of LI-RADS 2018 without a significant difference in specificity (93.9% vs. 95.4%, &lt;i&gt;P&lt;/i&gt;=0.314). Definite/probable HCC of KLCA-NCC 2018 had higher specificity (92.3% vs. 80.0%, &lt;i&gt;P&lt;/i&gt;=0.003) than LR-5/4 of LI-RADS 2018. The sensitivity was lower for definite/probable HCC than for LR-5/4 without statistical significance (85.6% vs. 88.1%, &lt;i&gt;P&lt;/i&gt;=0.057).Conclusions: On ECA-MRI, LI-RADS 2018 and KLCA-NCC 2018 showed comparable diagnostic performances. On HBA-MRI, definite HCC of KLCA-NCC 2018 provided better sensitivity than LR-5 category of LI-RADS 2018 without compromising the specificity, while definite/probable HCC of KLCA-NCC 2018 revealed higher specificity than LR-5/4 of LI-RADS 2018 for diagnosing HCC.</jats:p>

Diagnosis of hepatocellular carcinoma: Which MRI contrast agent? Which diagnostic criteria?

“…When washout timing was expanded, studies taking such ancillary imaging features into account successfully maintained high specificity (84.2–87.4%) [ 6 , 7 ], while studies not considering them reported low specificity (48.4–68.1%) [ 8 , 9 ]. However, it should be noted that the reported specificity in the study of Lee et al [ 5 ] was higher than that in previous studies. Their study may overestimate specificity as it only included surgically-proven malignancy.…”

“…In this issue of Clinical and Molecular Hepatology , Lee and colleagues [ 5 ] compare the diagnostic performance of LI-RADS 2018 and KLCA-NCC 2018 criteria in 273 treatment-naïve patients at high risk for HCC. Two hundred and two patients underwent HBA-MRI and 71 patients were evaluated with ECA-MRI.…”

“…Lee et al [ 5 ] showed that on HBA-MRI, the KLCA-NCC 2018 criteria showed significantly better sensitivity for definite HCC than did LI-RADS category 5 (LR-5; 79.1% vs. 68.2%, P <0.001), without a significant compromise in specificity. The difference in sensitivity between the two diagnostic criteria was more prominent for lesions smaller than 20 mm (KLCA-NCC vs. LI-RADS, 75.8% vs. 51.6%).…”

“…Lee et al [ 5 ] found that the specificity for definite HCC according to the KLCA-NCC 2018 criteria (93.9%) with washout criteria extended to the HBP was not significantly different to that of LR-5 (95.4%) with washout restricted to the PVP only. This high specificity of the KLCA-NCC 2018 criteria can be achieved by considering ancillary imaging features such as marked T2 hyperintensity or a targetoid appearance to exclude common causes of false-positive cases such as hemangiomas or non-HCC malignancy.…”

Serum Myostatin Predicts the Risk of Hepatocellular Carcinoma in Patients with Alcoholic Cirrhosis: A Multicenter Study

“…For patients who had equivocal findings on CT, MRI with liver-specific contrast was performed to diagnose HCC. If characteristic findings of HCC on MRI were not found, a liver biopsy was performed [ 21 , 22 , 23 , 24 , 25 , 26 ]. The study protocol complied with the ethical guidelines of the World Medical Association Declaration of Helsinki and was approved by the Institutional Review Board of each hospital.…”