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Evaluation of LI-RADS 3 category by magnetic resonance in US-detected nodules ≤ 2 cm in cirrhotic patients

  • Hepatobiliary-Pancreas
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Abstract

Objectives

Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) diagnosis in high-risk patients is a dynamic system, which was lastly updated in 2018. We aimed to evaluate the accuracy for HCC diagnosis of LI-RADS v2018 with magnetic resonance imaging (MRI) with extracellular contrast for solitary nodules ≤ 20 mm detected during ultrasound (US) surveillance in cirrhotic patients, with particular interest in those observations categorized as LI-RADS 3.

Methods

Between November 2003 and February 2017, we included 262 consecutive cirrhotic patients with a newly US-detected solitary ≤ 20-mm nodule. A LI-RADS (LR) v2018 category was retrospectively assigned. The diagnostic accuracy for each LR category was described, and the main MRI findings associated with HCC diagnosis were analyzed.

Results

Final diagnoses were as follows: 197 HCC (75.2%), 5 cholangiocarcinoma (1.9%), 2 metastasis (0.8%), and 58 benign lesions (22.1%); 0/15 (0%) LR-1, 6/26 (23.1%) LR-2, 51/74 (68.9%) LR-3, 11/12 (91.7%) LR-4, 126/127 (99.2%) LR-5, and 3/8 (37.5%) LR-M were HCC. LR-5 category displayed a sensitivity and specificity of 64% (95% CI, 56.8–70.7) and 98.5% (95% CI, 91.7–100), respectively. Considering also LR-4 as diagnostic for HCC, the sensitivity slightly increased to 69.5% (95% CI, 62.6–75.9) with minor impact on specificity (96.2%; 95% CI, 89.3–99.6). Regarding LR-3 observations, 51 out of 74 were HCC, 2 were non-HCC malignancies, and 20 out of 21 LR-3 nodules > 15 mm (95.2%) were finally categorized as HCC.

Conclusions

The high probability of HCC in US-detected LR-3 observations (68.9%) justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage.

Key Points

• In cirrhotic patients with nodules ≤ 20 mm detected during US surveillance, 51 out of 74 (68.9%) of LR-3 nodules by MRI corresponded to an HCC.

• In LR-3 nodules, HCC diagnosis was closely related to baseline tumor size. All 5 nodules smaller than 1 cm were diagnosed as benign. Oppositely, 20 out of 21 LR-3 observations > 15 mm (95.2%) were diagnosed as HCC.

• The high probability of HCC in US-detected LR-3 observations justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

ACR:

American College of Radiology

CT:

Computed tomography

EASL:

European Association for the Study of the Liver

FNB:

Fine-needle biopsy

HCC:

Hepatocellular carcinoma

iCCA:

Intrahepatic cholangiocarcinoma

LI-RADS/LR:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

NAFLD:

Non-alcoholic fatty liver disease

US:

Ultrasonography

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Acknowledgments

Álvaro Díaz-González: Grant support from the Instituto de Salud Carlos III (CM15/00050) and Ayuda Clínico Junior 2018 from the Asociación Española Contra el Cáncer (AECC).

María Reig: Grant support from Instituto de Salud Carlos III (PI15/00145 and PI18/00358).

Jordi Bruix: Grant support from Instituto de Salud Carlos III (PI14/00962 and PI18/00768), AECC (PI044031), Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2014 SGR 605), and WCR (AICR) 16-0026.

Alejandro Forner: Grant support from Instituto de Salud Carlos III (PI13/01229 and PI18/00542).

CIBERehd is funded by the Instituto de Salud Carlos III.

Funding

This study has received funding by Instituto de Salud Carlos III (PI18/00542).

Author information

Authors and Affiliations

  1. BCLC Group, Radiology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain

    Anna Darnell, Jordi Rimola, Ernest Belmonte, Enric Ripoll, Ángeles Garcia-Criado, Carla Caparroz, Ramón Vilana & Carmen Ayuso

  2. BCLC Group, Liver Unit, Hospital Clínic of Barcelona, Fundació Clínic per a la Recerca Biomédica (FCRB), IDIBAPS, University of Barcelona, Villarroel 170, Escala 11, 4a planta, 08036, Barcelona, Spain

    Álvaro Díaz-González, Ramón Vilana, María Reig, Jordi Bruix & Alejandro Forner

  3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain

    María Reig, Carmen Ayuso, Jordi Bruix & Alejandro Forner

Authors
  1. Anna Darnell
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Corresponding author

Correspondence to Alejandro Forner.

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Guarantor

The scientific guarantor of this publication is Alejandro Forner.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Anna Darnell, Álvaro Díaz-González, and Carmen Ayuso: Speaker fees and travel grants from Bayer.

Jordi Rimola: Speaker fees and travel grants from Bayer. Consultancy fees COR2ED.

Ernest Belmonte: Travel grants from BTG.

Enric Ripoll, Carla Caparroz, and Ramón Vilana: None.

Ángeles García-Criado: Speaker fees from BTG and Terumo.

María Reig: Consultancy from Bayer, BMS, Roche, Ipsen, AstraZeneca, and Lilly. Lecture fees from Bayer, BTG, BMS, Gilead, and Lilly. Research grants from Bayer and Lilly.

Jordi Bruix: Consultancy from Arqule, Bayer, Novartis, BMS, BTG-Biocompatibles, Eisai, Kowa, Terumo, Gilead, Bio-Alliance, Roche, AbbVie, Merck, Sirtex, Ipsen, Astra-Medimmune, Incyte, Quirem, Adaptimmune, and Lilly. Research grants from Bayer and BTG. Educational grants from Bayer and BTG. Lecture fees from Bayer, BTG-Biocompatibles, Eisai, Terumo, Sirtex, and Ipsen.

Alejandro Forner: Speaker fees from Bayer, Gilead, and MSD; consultancy fees from Bayer, AstraZeneca, and Guerbert.

None of those declared company relationships are related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper. Noteworthy, the corresponding author of this article (Alejandro Forner) has a degree on Investigation Methodology in Health Science and a Master in Methodology of Investigation in Health Science by the Universidad Autónoma de Barcelona, Spain.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Part of the population study was previously reported to validate the non-invasive diagnostic criteria for hepatocellular carcinoma (Forner A et al Hepatology 2008; 47:97–104), the limited value of intratumoral fat or peritumoral capsule to increase the diagnostic accuracy of MRI (Rimola J et al Journal of Hepatology 2012;56:1317–1323), and the evaluation of the diagnostic accuracy of LI-RADS v2013 (Darnell A et al Radiology. 2015;275:698–707). However, the results of the present study and the previous do not overlap and do not contain redundant information. In particular, the latter study in 2015 by Darnell et al included 133 patients and the lesions were evaluated according to LI-RADS v2013. In the present study, we included 129 additional patients, and the LI-RADS assessment was done with v2018.

Methodology

• Retrospective analysis of a prospective protocol

• Diagnostic or prognostic study

• Performed at one institution

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Darnell, A., Rimola, J., Belmonte, E. et al. Evaluation of LI-RADS 3 category by magnetic resonance in US-detected nodules ≤ 2 cm in cirrhotic patients. Eur Radiol 31, 4794–4803 (2021). https://doi.org/10.1007/s00330-020-07457-6

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