Modified LR-5 criteria based on gadoxetic acid can improve the sensitivity in the diagnosis of hepatocellular carcinoma.

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Yan Song, Yue-Yue Zhang, Qin Yu, Rui Ma, Yue Xiao, Jun-Kang Shen, Chao-Gang Wei
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引用次数: 0

Abstract

Background: Currently, only tumors classified as LR-5 are considered definitive hepatocellular carcinoma (HCC), and no further pathologic confirmation is required to initiate therapy. Previous studies have shown that the sensitivity of LR-5 is modest, and lesions enhanced by gadoxetic acid (Gd-EOB-DTPA) may exhibit lower sensitivity than those enhanced by Gd-DTPA.

Aim: To identify malignant ancillary features (AFs) that can independently and significantly predict HCC in Liver Imaging Reporting and Data System version 2018, and to develop modified LR-5 criteria to improve diagnostic performance on Gd-EOB-DTPA - enhanced magnetic resonance imaging.

Methods: Imaging data from patients with HCC risk factors who underwent abdominal Gd-EOB-DTPA - enhanced magnetic resonance imaging were collected. Univariate and multivariate logistic regression analyses were performed to determine AFs that could independently and significantly predict HCC. The modified LR-5 criteria involved reclassifying LR-4/LR-3 lesions based on major features combined with independently significant AFs for HCC, or by substituting threshold growth with significant AFs. McNemar's test was used to compare the diagnostic performance of the modified LR-5 criteria.

Results: A total of 244 lesions from 216 patients were included. Transitional phase hypointensity, mild - moderate T2 hyperintensity, and fat in mass (more than adjacent liver) were identified as significant independent predictors of HCC. Using the modified LR-5 criteria (e.g., LR-5-M1: LR-4 + transitional phase hypointensity; LR-5-M4: LR-5 by transitional phase hypointensity instead of threshold growth; LR-5-M5: LR-5 by mild - moderate T2 hyperintensity instead of threshold growth; LR-5-M8: LR-3/LR-4 + any two features of transitional phase hypointensity/mild - moderate T2 hyperintensity/fat in mass), sensitivities were significantly increased (88.5%-89.1%) compared to the standard LR-5 (60.6%; all P values < 0.05), while specificities (84.8%-89.9%) remained largely unchanged (93.7%; all P values > 0.05). The LR-5-M8 criterion achieved the highest sensitivity.

Conclusion: Mild - moderate T2 hyperintensity, transitional phase hypointensity, and fat in mass are independent and significant predictors of HCC malignant AFs. The modified LR-5 criteria can improve sensitivity without significantly reducing specificity.

改良的以加多己酸为基础的LR-5标准可提高肝细胞癌诊断的敏感性。
背景:目前,只有分类为LR-5的肿瘤才被认为是确定的肝细胞癌(HCC),并且不需要进一步的病理证实就可以开始治疗。既往研究表明,LR-5的敏感性一般,加多己酸(Gd-EOB-DTPA)增强的病变敏感性可能低于Gd-DTPA增强的病变。目的:在2018版《肝脏影像学报告与数据系统》中识别能够独立且显著预测HCC的恶性辅助特征(AFs),并制定修改后的LR-5标准,以提高Gd-EOB-DTPA增强磁共振成像的诊断效能。方法:收集HCC危险因素患者行腹部Gd-EOB-DTPA增强磁共振成像的影像学资料。进行单因素和多因素logistic回归分析,以确定能够独立且显著预测HCC的AFs。修改后的LR-5标准包括根据HCC的主要特征结合独立的显著AFs对LR-4/LR-3病变进行重新分类,或者用显著AFs代替阈值生长。采用McNemar试验比较修改后的LR-5标准的诊断性能。结果:共纳入216例患者的244个病灶。过渡期低密度、轻中度T2高强度和脂肪块(大于邻近肝脏)被认为是HCC的重要独立预测因素。使用修改后的LR-5标准(例如,LR-5- m1: LR-4 +过渡相低强度;LR-5- m4: LR-5由过渡相低密度而非阈值生长;LR-5- m5: LR-5通过轻度-中度T2高强度而不是阈值生长;与标准LR-5(60.6%)相比,LR-5- m8: LR-3/LR-4 +过渡期低密度/轻度-中度T2高强度/肿块脂肪的任意两个特征,敏感性显著提高(88.5%-89.1%);P值均< 0.05),而特异性(84.8% ~ 89.9%)基本保持不变(93.7%;P值均为> 0.05)。LR-5-M8判据的灵敏度最高。结论:轻中度T2高信号、过渡期低信号和肿块脂肪是HCC恶性AFs的独立且重要的预测因素。修改后的LR-5标准可提高敏感性,但不显著降低特异性。
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来源期刊
World journal of radiology
World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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8.00%
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