CT/MRI and CEUS LI-RADS Major Features Association with                     Hepatocellular Carcinoma: Individual Patient Data Meta-Analysis

Pol, Christian B. van der; McInnes, Matthew D. F.; Salameh, Jean‐Paul; Levis, Brooke; Chernyak, Victoria; Sirlin, Claude B.; Bashir, Mustafa R.; Allen, Brian C.; Burke, Lauren M.; Choi, Jong-Woo; Choi, Sang Hyun; Forner, Alejandro; Fraum, Tyler J.; Giamperoli, Alice; Jiang, Hanyu; Joo, Ijin; Kang, Zhuang; Kierans, Andrea S.; Kang, Hyo-Jin; Khatri, Gaurav; Kim, Jung Hoon; Kim, Do Young; Kim, So Yeon; Kim, Yeun-Yoon; Kwon, Heejin; Lee, Jeong Min; Lewis, Sara; McGinty, Katrina; Mulazzani, Lorenzo; Park, Mi‐Suk; Piscaglia, Fabio; Podgórska, Joanna; Reiner, Caecilia S.; Ronot, Maxime; Rosiak, Grzegorz; Song, Bin; Song, Ji Soo; Tang, An; Terzi, Eleonora; Wang, Jin; Wang, Wei; Wilson, Stephanie R.; Yokoo, Takeshi

doi:10.1148/radiol.2021211244

Cited by 49 publications

(45 citation statements)

References 56 publications

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“…However, there is no strong pathological support for threshold growth of HCC. In a previous multivariable analysis of CT/MRI LI-RADS, all MFs, except threshold growth, were associated with HCC (OR, 1.6; 95% CI: 0.7, 3.6; P = 0.07) [15]. In our study, there was no signi cant difference in threshold growth between HCCs and non-HCC malignancies.…”

Section: Discussioncontrasting

confidence: 45%

Threshold growth has a limited role in differentiating HCC from other focal hepatic lesions

Lyu

Wang

et al. 2023

Preprint

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Background The role of threshold growth, as one of the major features (MFs) of HCC in the Liver Imaging Reporting and Data System (LI-RADS) is inconsistent. This study evaluated the LI-RADS diagnostic performance for HCC when threshold growth was removed or replaced by highly frequent ancillary features (AFs). Methods This was a retrospective institutional review board-approved study including patients with a high HCC risk with gadoxetic acid-enhanced MRI findings consistent with pathologically proven focal hepatic observations. With pathological results used as the gold standard reference, the observations were divided into three groups: HCC, non-HCC malignancy and benign lesion. The sizes of the lesions with and without threshold growth were compared. The MFs and AFs of each observation were evaluated and compared among the three groups to select the most highly frequent AFs of HCC and was used to replace threshold growth. The LI-RADS categories of observations were categorized as follows: Scheme A, using all MFs and AFs according to LI-RADS v2018; scheme B, using all MFs except threshold growth, with threshold growth treated as an AF favouring malignancy; and scheme C, using the highly frequent AFs inplace of threshold growth as new MFs. The LR-5 (the category of definitely HCC) diagnostic performance for HCC among the 3 schemes was compared. Results A total of 379 patients and 426 observations were included. There was no statistically significant difference in the frequency of threshold growth between HCCs and non-HCC malignancies (p = 0.560). Whether HCCs, non-HCC malignancies, or benign lesions, the mean size with threshold growth was smaller than that without threshold growth (all p < 0.05). The nodule-in-nodule feature was a highly frequent AF (p < 0.05) and was used to replace threshold growth as a new MF in scheme C. The LR-5 diagnostic performance values for HCC with schemes A, B, and C were respectively as follows: a sensitivity of 74.4%, 74.0% and 75.6%; specificity of 88.6%, 88.6% and 88.6%; and accuracy of 80.3%, 80.0% and 81.0%. There was no statistically significant difference in diagnostic performance between schemes A and B or between schemes A and C (all p > 0.05). Conclusion The threshold growth is removed or replaced by the nodule-in-nodule feature

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Section: Discussioncontrasting

confidence: 45%

Threshold growth has a limited role in differentiating HCC from other focal hepatic lesions

Lyu

Wang

et al. 2023

Preprint

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“…Dies bedeutet, dass das arterielle Phase Hyperenhancement am sensitivsten im Nachweis eines HCC, die enhancende Pseudokapsel dafür sehr spezifisch ist (wenige falsch positive Diagnosen). Diese Ergebnisse wurden durch die Studie von van der Pol et al, die den diagnostischen Wert der einzelnen Hauptkriterien analysierte, im Wesentlichen bestätigt: Die Hauptkriterien arterielle Phase Hyperenhancement, Wash-Out, kontrastmittelaufnehmende Pseudokapsel und Größe ≥ 20 mm waren, mit Ausnahme des Hauptkriteriums Schwellenwachstum, signifikant mit der Diagnose HCC assoziiert 27 .…”

Section: Li-rads-kategorienunclassified

LI-RADS Made Easy

Schima

Kopf

Eisenhuber

2023

Rofo

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Purpose The Liver Imaging Reporting and Data System (LI-RADS v2018) standardizes the interpretation and reporting of MDCT and MRI examinations in patients at risk for hepatocellular carcinoma (HCC). Materials and Methods For focal liver lesions (called “observations”) it assigns categories (LR-1 to 5, LR-M, LR-TIV, LR-TR), which reflect the probability of benignity or malignancy (HCC or other non-HCC malignancies) of the respective observation. The categories assigned are based on major and ancillary image features, which have been developed by the American College of Radiology (ACR), revised several times (now v2018), and validated in many studies. The value of ancillary features to modify LI-RADS categories assigned to observations based on major features is shown. Results This review summarizes the relevant CT and MRI features and presents a step-by-step approach for readers not familiar with LI-RADS on how to use the system. Relevant imaging features and the value of different modalities (contrast-enhanced CT, MRI with extracellular gadolinium chelates or liver-specific contrast agents) is explained. Conclusion The widespread adoption of LI-RADS for CT/MRI reporting in high-risk patients would help to reduce inter-reader variability. It could improve communication between radiologists, oncologists, hepatologists, pathologists, and liver surgeons, and lead to better patient management. Key points: Citation Format

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“…Due to its high specificity, this temporal enhancement hallmark is incorporated in all current diagnostic systems. As emerged from a recent meta-analysis, the APHE and washout are the strongest independent imaging features associated with HCC [ 155 ]. APHE is defined as the presence of nonrimlike enhancement of an observation that is unequivocally of higher intensity/attenuation than background liver [ 155 ].…”

Section: Li-radsmentioning

confidence: 99%

“…As emerged from a recent meta-analysis, the APHE and washout are the strongest independent imaging features associated with HCC [ 155 ]. APHE is defined as the presence of nonrimlike enhancement of an observation that is unequivocally of higher intensity/attenuation than background liver [ 155 ]. This appearance is referable to the high arterial flow in advanced HCC due to angiogenesis and formation of nontriadal or unpaired neoarteries [ 156 ].…”

Section: Li-radsmentioning

confidence: 99%

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

et al. 2022

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Liver cancer is the sixth most detected tumor and the third leading cause of tumor death worldwide. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with specific risk factors and a targeted population. Imaging plays a major role in the management of HCC from screening to post-therapy follow-up. In order to optimize the diagnostic-therapeutic management and using a universal report, which allows more effective communication among the multidisciplinary team, several classification systems have been proposed over time, and LI-RADS is the most utilized. Currently, LI-RADS comprises four algorithms addressing screening and surveillance, diagnosis on computed tomography (CT)/magnetic resonance imaging (MRI), diagnosis on contrast-enhanced ultrasound (CEUS) and treatment response on CT/MRI. The algorithm allows guiding the radiologist through a stepwise process of assigning a category to a liver observation, recognizing both major and ancillary features. This process allows for characterizing liver lesions and assessing treatment. In this review, we highlighted both major and ancillary features that could define HCC. The distinctive dynamic vascular pattern of arterial hyperenhancement followed by washout in the portal-venous phase is the key hallmark of HCC, with a specificity value close to 100%. However, the sensitivity value of these combined criteria is inadequate. Recent evidence has proven that liver-specific contrast could be an important tool not only in increasing sensitivity but also in diagnosis as a major criterion. Although LI-RADS emerges as an essential instrument to support the management of liver tumors, still many improvements are needed to overcome the current limitations. In particular, features that may clearly distinguish HCC from cholangiocarcinoma (CCA) and combined HCC-CCA lesions and the assessment after locoregional radiation-based therapy are still fields of research.

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CT/MRI and CEUS LI-RADS Major Features Association with Hepatocellular Carcinoma: Individual Patient Data Meta-Analysis

Cited by 49 publications

References 56 publications

Threshold growth has a limited role in differentiating HCC from other focal hepatic lesions

Threshold growth has a limited role in differentiating HCC from other focal hepatic lesions

LI-RADS Made Easy

A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

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