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

IF 4.2 3区医学 Q2 ONCOLOGY

Journal of Hepatocellular Carcinoma Pub Date : 2024-04-26 DOI:10.2147/jhc.s448257

Runqian Huang, Chunling Zheng, Guixiao Xu, Xuanwei Chen, Jingxian Shen, Siyue Mao

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Abstract

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.

Keywords: hepatic tumors, malignant, targetoid feature, Rim APHE, liver imaging reporting and data system

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一种强调薄缘 APHE 的改良 Targetoid 特征可提高 LI-RADS 对恶性肝肿瘤的诊断性能

目的确定有助于区分HCC和被归入LI-RADS M（LR-M）的非HCC恶性肿瘤的成像特征，并评估使用薄缘动脉相增强（APHE）的LI-RADS的诊断性能：这项回顾性研究纳入了 381 例（观察 387 例）HCC 高危患者，他们都在手术前接受了增强型 MRI 检查。三名放射科医生对图像进行了审查，以便对肝脏观察结果进行 LI-RADS 分类。我们进行了单变量和多变量分析，以确定在 LR-M 病变中区分 HCC 和非 HCC 恶性肿瘤的可靠特征。根据APHE边缘与肿瘤半径相比的最厚厚度定义了薄边缘（< 30% ）APHE，并建立了强调薄边缘APHE作为LR-M特异特征的改良LI-RADS。我们比较了改良 LR-M 和 LI-RADS 5（LR-5）与传统 LR-M 的诊断性能：结果：发现薄缘 APHE 和靶状弥散加权成像（DWI）是非 HCC 恶性肿瘤的独立预测因素，而增强囊、厚缘 APHE 和外周冲洗是与 LR-M HCC 显著相关的独立变量（P< 0.05）。利用 ROC 曲线，薄缘 APHE 在区分非 HCC 恶性肿瘤和 HCC 方面具有明显的诊断性能。与 LR-M 相比，强调薄层 APHE 靶状特征的改良 LR-M 在保持高灵敏度（82.2% vs 86.0%；P=0.529）的同时，特异性和准确性也明显优于 LR-M（分别为 89.4% vs 81.1%，P=0.004；87.9% vs 82.2%，P=0.027）。同时，与 LR-5 相比，改良 LR-5 诊断 HCC 的灵敏度和准确性更高（分别为 88.6% vs 79.7%，P=0.004；85.8% vs 80.1%，P=0.036），而特异性（78.3% vs 81.1%；P=0.608）却没有降低：薄缘 APHE 可能是 LR-M 鉴别非 HCC 恶性肿瘤和 HCC 的特异性成像特征。关键词：肝脏肿瘤；恶性；类靶组织特征；Rim APHE；肝脏成像报告和数据系统

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