Diagnosis of Hepatocellular Carcinoma Using Gadoxetic Acid-Enhanced MRI Based on LI-RADS Version 2018 and LI-RADS Modifications

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-10-03 DOI:10.1111/liv.70366

Yanjin Qin, Jing Zhang, Danyang Xu, Xiaoqi Zhou, Zhoukun Ling, Lujie Li, Qiaochu Zhao, Zhi Dong, Jifei Wang, Hua-Song Cai, Hongxiang Li, Lie-Guang Zhang, Shi-Ting Feng

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引用次数: 0

Abstract

Objectives

The diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 (v2018), its modifications modified LI-RADS (mLI-RADS) and revised LI-RADS (rLI-RADS), for diagnosing hepatocellular carcinoma (HCC) remains poorly understood and requires further validation. This multicentre study aimed to evaluate the diagnostic performance of three algorithms in diagnosing HCC.

Methods

We included 1092 untreated patients at risk for developing HCC who underwent gadoxetic acid–enhanced MRI across three independent cohorts from January 2020 to December 2022. Two readers independently interpreted each hepatic lesion and recorded their imaging features. The readers' judgements regarding whether the lesion was HCC or not were also noted. Non-HCC cases were confirmed based on histologic and clinical follow-up data, while HCC cases were pathologically confirmed. Diagnostic performance metrics were compared using bootstrap resampling and generalised estimating equations. Additionally, the diagnostic odds ratio (DOR) was evaluated.

Results

Of 1313 lesions, 52.3% (687/1313) were diagnosed as HCC. For all hepatic lesions, mLI-RADS achieved higher sensitivity (82.9%) and accuracy (84.1%) than LI-RADS v2018 (sensitivity, 79.9%, p = 0.024; accuracy, 83.2%) and rLI-RADS (sensitivity, 81.3%; accuracy, 83.8%), while maintaining a similar positive predictive value (mLI-RADS, 86.2%; LI-RADS v2018, 86.9%; rLI-RADS, 86.9%). The DORs were 28.3 (95% CI: 21.1–38.0) for mLI-RADS, 27.8 (95% CI: 20.6–37.7) for LI-RADS v2018 and 26.0 (95% CI: 19.3–35.0) for rLI-RADS. The readers' judgement exhibited higher accuracy than that of three algorithms (87.7%: 83.2%–84.1%).

Conclusion

For the diagnosis of HCC in an HBV-predominant cohort, mLI-RADS showed higher performance compared with LI-RADS v2018 and rLI-RADS. Reader judgement achieved higher accuracy than all algorithms, highlighting the role of clinical expertise.

Trial Registration

NCT06663904

Abstract Image

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基于LI-RADS版本2018和LI-RADS改进的Gadoxetic酸增强MRI诊断肝细胞癌

目的肝脏影像报告与数据系统（LI-RADS） 2018版（v2018）及其修改后的LI-RADS （mLI-RADS）和修订后的LI-RADS （rLI-RADS）在诊断肝细胞癌（HCC）方面的诊断性能仍然知之甚少，需要进一步验证。这项多中心研究旨在评估三种诊断HCC的算法的诊断性能。方法：我们纳入了1092名未经治疗的HCC风险患者，这些患者在2020年1月至2022年12月期间接受了加多西酸增强MRI检查。两位读者独立解读每个肝脏病变并记录其影像学特征。并注意到读者对病变是否为HCC的判断。非HCC病例根据组织学和临床随访资料确诊，HCC病例通过病理确诊。使用自举重采样和广义估计方程对诊断性能指标进行比较。此外，评估诊断优势比（DOR）。结果1313个病变中，52.3%（687/1313）被诊断为HCC。对于所有肝脏病变，mLI-RADS的敏感性（82.9%）和准确性（84.1%）均高于LI-RADS v2018（敏感性79.9%,p = 0.024；准确性83.2%）和rLI-RADS（敏感性81.3%；准确性83.8%），同时保持相似的阳性预测值（mLI-RADS, 86.2%; LI-RADS v2018, 86.9%; rLI-RADS, 86.9%）。mLI-RADS的DORs为28.3 (95% CI: 21.1-38.0)， LI-RADS v2018的DORs为27.8 (95% CI: 20.6-37.7)， rLI-RADS的DORs为26.0 （95% CI: 19.3-35.0）。读者判断的准确率高于三种算法（87.7%:83.2%-84.1%）。结论在hbv为主的人群中，与LI-RADS v2018和rLI-RADS相比，mLI-RADS具有更高的HCC诊断效能。读者判断的准确率高于所有算法，突出了临床专业知识的作用。试验注册编号NCT06663904

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.