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Abdominal Radiology

, Volume 44, Issue 2, pp 517–528 | Cite as

LI-RADS for CT diagnosis of hepatocellular carcinoma: performance of major and ancillary features

  • Ayman Alhasan
  • Milena Cerny
  • Damien Olivié
  • Jean-Sébastien Billiard
  • Catherine Bergeron
  • Kip Brown
  • Paule Bodson-Clermont
  • Hélène Castel
  • Simon Turcotte
  • Pierre Perreault
  • An TangEmail author
Article
  • 252 Downloads

Abstract

Purpose

To evaluate the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) v2017 major features, the impact of ancillary features, and categories on contrast-enhanced computed tomography (CECT) for the diagnosis of hepatocellular carcinoma (HCC).

Materials and methods

This retrospective study included 59 patients (104 observations including 72 HCCs) with clinical suspicion of HCC undergoing CECT between 2013 and 2016. Two radiologists independently assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS category based on major features only and in combination with ancillary features. The composite reference standard included pathology or imaging. Per-lesion estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed by generalized estimating equation models.

Results

Major features (arterial phase hyperenhancement, washout, capsule, and threshold growth) respectively had a sensitivity of 86.1%, 81.6%, 20.7%, and 26.1% and specificity of 39.3%, 67.9%, 89.9%, and 85.0% for HCC. Ancillary features (ultrasound visibility as discrete nodule, subthreshold growth, and fat in mass more than adjacent liver) respectively had a sensitivity of 42.6%, 50.8%, and 15.1% and a specificity of 79.2%, 66.9%, and 96.4% for HCC. Ancillary features modified the final category in 4 of 104 observations. For HCC diagnosis, categories LR-3, LR-4, LR-5, and LR-TIV (tumor in vein) had a sensitivity of 5.3%, 29.0%, 53.7%, and 10.7%; and a specificity of 49.1%, 84.4%, 97.3%, and 96.4%, respectively.

Conclusion

On CT, LR-5 category has near-perfect specificity for the diagnosis of HCC and ancillary features modifies the final category in few observations.

Key words

LI-RADS Hepatocellular carcinoma Major features Ancillary features Category CT 

Notes

Compliance with ethical standards

Conflict of interest

Ayman Alhasan, Milena Cerny, Damien Olivié, Jean-Sébastien Billiard, Catherine Bergeron, Kip Brown, Paule Bodson-Clermont, Hélène Castel, Simon Turcotte, Pierre Perreault and An Tang declare that they have no conflict of interest.

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.

Informed consent

Informed consent was waived from all individual participants included in the study.

Supplementary material

261_2018_1762_MOESM1_ESM.docx (66 kb)
Supplementary material 1 (DOCX 66 kb)

References

  1. 1.
    Mittal S, El-Serag HB (2013) Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol 47(Suppl):S2–S6.  https://doi.org/10.1097/MCG.0b013e3182872f29 PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Omata M, Lesmana LA, Tateishi R, et al. (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4(2):439–474.  https://doi.org/10.1007/s12072-010-9165-7 PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    American College of Radiology. (2018) Liver Imaging Reporting and Data System (LI-RADS) version 2017. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS. Accessed April 20, 2018
  4. 4.
    Heimbach JK, Kulik LM, Finn RS, et al. (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67(1):358–380.  https://doi.org/10.1002/hep.29086 PubMedCrossRefGoogle Scholar
  5. 5.
    European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol .  https://doi.org/10.1016/j.jhep.2018.03.019 CrossRefGoogle Scholar
  6. 6.
    Elsayes KM, Hooker JC, Agrons MM, et al. (2017) 2017 version of LI-RADS for CT and MR imaging: an update. Radiographics 37(7):1994–2017.  https://doi.org/10.1148/rg.2017170098 PubMedCrossRefGoogle Scholar
  7. 7.
    Tang A, Bashir MR, Corwin MT, et al. (2018) Evidence supporting LI-RADS major features for CT- and MR imaging-based diagnosis of hepatocellular carcinoma: a systematic review. Radiology 286(1):29–48.  https://doi.org/10.1148/radiol.2017170554 PubMedCrossRefGoogle Scholar
  8. 8.
    Organ Procurement and Transplantation Network. (2018) OPTN/UNOS policy 9: allocation of livers and liver-intestines. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Accessed April 20, 2018
  9. 9.
    Fowler KJ, Tang A, Santillan C, et al. (2018) Interreader reliability of LI-RADS version 2014 algorithm and imaging features for diagnosis of hepatocellular carcinoma: a large international multireader study. Radiology 286(1):173–185.  https://doi.org/10.1148/radiol.2017170376 PubMedCrossRefGoogle Scholar
  10. 10.
    Fraum TJ, Tsai R, Rohe E, et al. (2018) Differentiation of hepatocellular carcinoma from other hepatic malignancies in patients at risk: diagnostic performance of the liver imaging reporting and data system version 2014. Radiology 286(1):158–172.  https://doi.org/10.1148/radiol.2017170114 PubMedCrossRefGoogle Scholar
  11. 11.
    Cerny M, Bergeron C, Billiard JS, Murphy-Lavallee J, Olivie D, Berube J, Fan B, Castel H, Turcotte S, Perreault P, Chagnon M, Tang A (2018) LI-RADS for MR imaging diagnosis of hepatocellular carcinoma: performance of major and ancillary features. Radiology.  https://doi.org/10.1148/radiol.2018171678
  12. 12.
    Joo I, Lee JM, Lee DH, et al. (2017) Liver imaging reporting and data system v2014 categorization of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: comparison with multiphasic multidetector computed tomography. J Magn Reson Imaging 45(3):731–740.  https://doi.org/10.1002/jmri.25406 PubMedCrossRefGoogle Scholar
  13. 13.
    Ronot M, Fouque O, Esvan M, et al. (2017) Comparison of the accuracy of AASLD and LI-RADS criteria for the non-invasive diagnosis of HCC smaller than 3 cm. J Hepatol .  https://doi.org/10.1016/j.jhep.2017.12.014 PubMedCrossRefGoogle Scholar
  14. 14.
    Choi JY, Lee JM, Sirlin CB (2014) CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 273(1):30–50.  https://doi.org/10.1148/radiol.14132362 PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Lee JM, Yoon JH, Joo I, Woo HS (2012) Recent advances in CT and MR imaging for evaluation of hepatocellular carcinoma. Liver Cancer 1(1):22–40.  https://doi.org/10.1159/000339018 PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Chou R, Cuevas C, Fu R, et al. (2015) Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Ann Intern Med 162(10):697–711.  https://doi.org/10.7326/M14-2509 PubMedCrossRefGoogle Scholar
  17. 17.
    Hanna RF, Miloushev VZ, Tang A, et al. (2016) Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma. Abdom Imaging. 41(1):71–90.  https://doi.org/10.1007/s00261-015-0592-8 CrossRefGoogle Scholar
  18. 18.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174PubMedCrossRefGoogle Scholar
  19. 19.
    Bolondi L, Gaiani S, Celli N, et al. (2005) Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42(1):27–34.  https://doi.org/10.1002/hep.20728 PubMedCrossRefGoogle Scholar
  20. 20.
    Forner A, Vilana R, Ayuso C, et al. (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47(1):97–104.  https://doi.org/10.1002/hep.21966 PubMedCrossRefGoogle Scholar
  21. 21.
    Oliver JH 3rd, Baron RL, Federle MP, Rockette HE Jr (1996) Detecting hepatocellular carcinoma: value of unenhanced or arterial phase CT imaging or both used in conjunction with conventional portal venous phase contrast-enhanced CT imaging. AJR Am J Roentgenol 167(1):71–77.  https://doi.org/10.2214/ajr.167.1.8659425 PubMedCrossRefGoogle Scholar
  22. 22.
    Laghi A, Iannaccone R, Rossi P, et al. (2003) Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology 226(2):543–549.  https://doi.org/10.1148/radiol.2262012043 PubMedCrossRefGoogle Scholar
  23. 23.
    Sangiovanni A, Manini MA, Iavarone M, et al. (2010) The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 59(5):638–644.  https://doi.org/10.1136/gut.2009.187286 PubMedCrossRefGoogle Scholar
  24. 24.
    Bruix J, Reig M, Rimola J, et al. (2011) Clinical decision making and research in hepatocellular carcinoma: pivotal role of imaging techniques. Hepatology 54(6):2238–2244.  https://doi.org/10.1002/hep.24670 PubMedCrossRefGoogle Scholar
  25. 25.
    Burrel M, Llovet JM, Ayuso C, et al. (2003) MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 38(4):1034–1042.  https://doi.org/10.1053/jhep.2003.50409 PubMedCrossRefGoogle Scholar
  26. 26.
    Serste T, Barrau V, Ozenne V, et al. (2012) Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: role of biopsy. Hepatology 55(3):800–806.  https://doi.org/10.1002/hep.24746 PubMedCrossRefGoogle Scholar
  27. 27.
    Jang HJ, Kim TK, Khalili K, et al. (2013) Characterization of 1-to 2-cm liver nodules detected on hcc surveillance ultrasound according to the criteria of the American Association for the Study of Liver Disease: is quadriphasic CT necessary? AJR Am J Roentgenol 201(2):314–321.  https://doi.org/10.2214/AJR.12.9341 PubMedCrossRefGoogle Scholar
  28. 28.
    Khan AS, Hussain HK, Johnson TD, et al. (2010) Value of delayed hypointensity and delayed enhancing rim in magnetic resonance imaging diagnosis of small hepatocellular carcinoma in the cirrhotic liver. J Magn Reson Imaging 32(2):360–366.  https://doi.org/10.1002/jmri.22271 PubMedCrossRefGoogle Scholar
  29. 29.
    Rimola J, Forner A, Tremosini S, et al. (2012) Non-invasive diagnosis of hepatocellular carcinoma </= 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 56(6):1317–1323.  https://doi.org/10.1016/j.jhep.2012.01.004 PubMedCrossRefGoogle Scholar
  30. 30.
    An C, Park MS, Kim D, et al. (2013) Added value of subtraction imaging in detecting arterial enhancement in small (< 3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma. Eur Radiol 23(4):924–930.  https://doi.org/10.1007/s00330-012-2685-x PubMedCrossRefGoogle Scholar
  31. 31.
    Suh YJ, Kim MJ, Choi JY, et al. (2011) Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol 197(1):W44–W52.  https://doi.org/10.2214/ajr.10.5845 PubMedCrossRefGoogle Scholar
  32. 32.
    Dioguardi Burgio M, Picone D, Cabibbo G, et al. (2016) MR-imaging features of hepatocellular carcinoma capsule appearance in cirrhotic liver: comparison of gadoxetic acid and gadobenate dimeglumine. Abdom Radiol (NY) 41(8):1546–1554.  https://doi.org/10.1007/s00261-016-0726-7 CrossRefGoogle Scholar
  33. 33.
    Darnell A, Forner A, Rimola J, et al. (2015) Liver Imaging Reporting and Data System with MR Imaging: evaluation in Nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275(3):698–707.  https://doi.org/10.1148/radiol.15141132 PubMedCrossRefGoogle Scholar
  34. 34.
    Zhang YD, Zhu FP, Xu X, et al. (2016) Classifying CT/MR findings in patients with suspicion of hepatocellular carcinoma: comparison of liver imaging reporting and data system and criteria-free Likert scale reporting models. J Magn Reson Imaging 43(2):373–383.  https://doi.org/10.1002/jmri.24987 PubMedCrossRefGoogle Scholar
  35. 35.
    Ehman EC, Behr SC, Umetsu SE, et al. (2016) Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. Abdom Radiol (NY) 41(5):963–969.  https://doi.org/10.1007/s00261-015-0623-5 PubMedCentralCrossRefGoogle Scholar
  36. 36.
    Bashir MR, Huang R, Mayes N, et al. (2015) Concordance of hypervascular liver nodule characterization between the organ procurement and transplant network and liver imaging reporting and data system classifications. J Magn Reson Imaging 42(2):305–314.  https://doi.org/10.1002/jmri.24793 PubMedCrossRefGoogle Scholar
  37. 37.
    Denecke T, Grieser C, Froling V, et al. (2009) Multislice computed tomography using a triple-phase contrast protocol for preoperative assessment of hepatic tumor load in patients with hepatocellular carcinoma before liver transplantation. Transpl Int 22(4):395–402.  https://doi.org/10.1111/j.1432-2277.2008.00793.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ayman Alhasan
    • 1
    • 2
  • Milena Cerny
    • 3
  • Damien Olivié
    • 1
  • Jean-Sébastien Billiard
    • 1
  • Catherine Bergeron
    • 1
  • Kip Brown
    • 3
  • Paule Bodson-Clermont
    • 3
  • Hélène Castel
    • 4
  • Simon Turcotte
    • 3
    • 5
  • Pierre Perreault
    • 1
  • An Tang
    • 1
    • 3
    • 6
    Email author
  1. 1.Department of RadiologyCentre Hospitalier de l’Université de Montréal (CHUM)MontrealCanada
  2. 2.Faculty of MedicineTaibah UniversityMedinaSaudi Arabia
  3. 3.Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM)MontrealCanada
  4. 4.Department of Hepatology and Liver TransplantationCentre Hospitalier de l’Université de Montréal (CHUM)MontrealCanada
  5. 5.Department of Surgery, Hepatopancreatobiliary and Liver Transplantation ServiceCentre Hospitalier de l’Université de Montréal (CHUM)MontrealCanada
  6. 6.Department of Radiology, Radio-Oncology and Nuclear MedicineUniversity of MontrealMontrealCanada

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