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Abdominal Radiology

, Volume 44, Issue 9, pp 3078–3088 | Cite as

Optimal lexicon of gadoxetic acid-enhanced magnetic resonance imaging for the diagnosis of hepatocellular carcinoma modified from LI-RADS

  • Shin Hye Hwang
  • Sumi Park
  • Kyunghwa Han
  • Jin-young Choi
  • Young-Nyun Park
  • Mi-Suk ParkEmail author
Hepatobiliary
  • 107 Downloads

Abstract

Purpose

To define the optimal lexicon of major imaging findings on gadoxetic acid-enhanced MRIs to diagnose HCC to improve diagnostic performance of the LI-RADS.

Methods

Two hundred forty-one hepatic lesions (149 HCC, six other malignancies, 86 benign lesions) in 177 treatment-naïve patients at risk of HCC who underwent gadoxetic acid-MRIs from January 2013 to December 2015 were retrospectively reviewed using either histopathological or follow-up imaging findings as a standard reference. Two board-certified radiologists independently evaluated the imaging features and categorized the nodules based on the original and the following modified definitions in LI-RADS: (1) washout appearance in the portal venous phase (PVP) only versus that in the PVP or transitional phase, and (2) enhancing capsule only versus enhancing or non-enhancing capsule. Diagnostic performance and inter-observer agreement of LR-5 were assessed and compared between the algorithms using generalized estimation equation.

Results

The sensitivity [79.2% (95% confidence interval 71.9, 85.0)] and accuracy [84.6% (79.5, 88.7)] of LR-5 were significantly higher for modified lexicon compared with original LI-RADS [60.4% (52.3, 67.9) and 73.9% (67.9, 79.0); P < 0.001 in all cases]. There was no significant difference in specificity [93.5% (86.2, 97.0) and 95.7% (89.0, 98.4); P = 0.153]. Subgroups of lesions < or ≥ 2 cm showed similar tendencies. Inter-observer agreement for capsule appearance was fair to moderate, whereas that for other imaging findings was good to excellent.

Conclusions

Compared to original LI-RADS, LI-RADS with modified lexicon showed higher sensitivity for the diagnosis of HCC using gadoxetic acid-MRI, with similar specificity.

Keywords

Hepatocellular carcinoma Diagnosis MRI (Magnetic resonance imaging) Gadoxetic acid 

Notes

Funding

All authors declare that they have nothing to disclose about funding with respect to this manuscript.

Compliance with ethical standards

Conflict of interest

The authors of this study declared that they have nothing to disclose regarding conflict of interest with respect to this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

261_2019_2077_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyNational Health Insurance Service Ilsan HospitalGoyangSouth Korea
  2. 2.Department of RadiologySeverance HospitalSeoulSouth Korea
  3. 3.Department of Radiology, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  4. 4.Department of PathologyYonsei University College of MedicineSeoulSouth Korea

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