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An improved diagnostic algorithm for subcentimeter hepatocellular carcinoma on gadoxetic acid–enhanced MRI

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Accurate diagnosis of subcentimeter hepatocellular carcinoma (HCC) is a challenge also with gadoxetic acid–enhanced MRI (EOB-MRI). This study aimed to assess the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) for subcentimeter HCC and to determine whether new diagnostic criteria (washout either on portal venous phase (PVP) or transitional phase (TP)) would improve the diagnostic performance.

Methods

We evaluated 240 subcentimeter observations in 225 consecutive treatment-naïve patients at risk of HCC. Final diagnoses were 132 HCCs (all by pathology) and 108 non-HCC (41 by pathology and 67 by follow-up). Two radiologists assessed MR imaging features and assigned LI-RADS categories. A variety of diagnostic criteria were developed by combining significant MRI features based on washout on PVP or TP. Diagnostic performance was compared.

Results

Non-rim arterial phase hyperenhancement (non-rim APHE), washout on PVP or TP, and hepatobiliary-phase hypointensity were significant predictors for subcentimeter HCC diagnosis according to multivariable analysis. One criterion (non-rim APHE and washout on PVP or TP) yielded higher sensitivity (68.2% vs. 56.8%, p = 0.011) with comparable specificity (91.7% vs. 92.6%, p > 0.999) compared to the LR-4 category. This criterion had improved sensitivity (68.2% vs. 49.2%, p < 0.001) and slightly decreased specificity (91.7% vs. 94.4%, p = 0.250) compared to non-rim APHE with washout on PVP.

Conclusions

LI-RADS exhibits modest diagnostic performance for subcentimeter HCC. Our new criterion (non-rim APHE and non-peripheral washout on PVP or TP) may increase the diagnostic sensitivity without compromised specificity compared to the LR-4 category.

Key Points

• The LR-4 category shows modest diagnostic performance for the diagnosis of subcentimeter HCC on EOB-MRI with a sensitivity and specificity of 56.8% and 92.6%, respectively.

• Non-rim APHE, non-peripheral washout on PVP or TP, and HBP hypointensity were independent predictors for the diagnosis of subcentimeter HCC.

• The combination of non-rim APHE and non-peripheral washout on PVP or TP improves the sensitivity from 56.8 to 68.2% (p = 0.011) with comparable specificity (91.7 vs. 92.6%, p > 0.999).

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Abbreviations

APHE:

Arterial phase hyperenhancement

EOB-MRI:

Gadoxetic acid–enhanced MRI

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

PVP:

Portal venous phase

TP:

Transitional phase

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Funding

This study has received funding by the Clinical Research Plan of SHDC (grant number SHDC2020CR1029B), National Natural Science Foundation of China (grant number 82171897), Shanghai Municipal Key Clinical Specialty (grant number shslczdzk03202), and Clinical Research Project of Zhongshan Hospital, Fudan University (grant number 2020ZSLC61).

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Author notes

  1. Peng Huang and Changwu Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China

    Peng Huang, Changwu Zhou, Fei Wu, Yuyao Xiao, Xianling Qian, Yi Wang, Chun Yang & Mengsu Zeng

  2. Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China

    Peng Huang, Changwu Zhou, Fei Wu, Yuyao Xiao, Xianling Qian, Yi Wang, Chun Yang & Mengsu Zeng

  3. Shanghai Institute of Medical Imaging, Shanghai, China

    Changwu Zhou & Mengsu Zeng

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  1. Peng Huang
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Corresponding authors

Correspondence to Chun Yang or Mengsu Zeng.

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The scientific guarantor of this publication is Mengsu Zeng.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

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• retrospective

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Huang, P., Zhou, C., Wu, F. et al. An improved diagnostic algorithm for subcentimeter hepatocellular carcinoma on gadoxetic acid–enhanced MRI. Eur Radiol 33, 2735–2745 (2023). https://doi.org/10.1007/s00330-022-09282-5

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  • DOI: https://doi.org/10.1007/s00330-022-09282-5

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