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LI-RADS v2018: how to appropriately use ancillary features in category adjustment from intermediate probability of malignancy (LR-3) to probably HCC (LR-4) on gadoxetic acid–enhanced MRI

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To determine the appropriate use of ancillary features (AFs) in upgrading LI-RADS category 3 (LR-3) to category 4 (LR-4) for hepatic nodules on gadoxetic acid–enhanced MRI.

Methods

We retrospectively analyzed MRI features of solid hepatic nodules (≤ 30 mm) categorized as LR-3/4 on gadoxetic acid–enhanced MRI. In LI-RADS diagnostic table-based-LR-3 observations, logistic regression analyses were performed to identify AFs suggestive of hepatocellular carcinomas (HCCs) rather than non-malignant nodules. Using McNemar’s test, the sensitivities and specificities of the final-LR-4 category for HCC diagnosis were compared according to the principles of AF application in category adjustment.

Results

A total of 336 hepatic nodules (191 HCCs; 145 non-malignant) in 252 patients were evaluated. Based on major HCC features, 248 nodules (123 HCCs) were assigned as table-based-LR-3 and 88 nodules (68 HCCs) as table-based-LR-4. In table-based-LR-3 observations, mild–moderate T2 hyperintensity was identified as an independent predictor of HCC as opposed to non-malignant nodules (odds ratio = 3.01, p = 0.002). For HCC diagnosis, different criteria of final-LR-4: only table-based-LR-4, allowing category upgrade using only T2 hyperintensity, or using any AFs favoring malignancy resulted in sensitivities of 35.6% (68/191), 53.9% (103/191), and 88.5% (169/191), and specificities of 86.2% (125/145), 75.9% (110/145), and 21.4% (31/145), respectively, which differed from each other (all p < 0.001).

Conclusions

While the application of MRI AF in LI-RADS category adjustment increases the sensitivity of LR-4 category for HCC diagnosis, it is accompanied by a significant decrease in specificity. Mild–moderate T2 hyperintensity, a significant AF indicative of HCC, may be more appropriate for upgrading LR-3 to LR-4.

Key Points

• When upgrading from LR-3 to LR-4 using any MRI ancillary features favoring malignancy, LR-4 sensitivity increases but specificity decreased for HCC diagnosis.

• By upgrading LR-3 to LR-4 based on MRI ancillary features found to suggest HCC rather than non-malignant nodules in multivariate analysis (i.e., mild–moderate T2 hyperintensity), LR-4 demonstrated a more balanced sensitivity and specificity for HCC diagnosis (53.9% and 75.9%, respectively).

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Abbreviations

AF:

Ancillary feature

APHE:

Arterial-phase hyperenhancement

DN:

Dysplastic nodule

DWI:

Diffusion-weighted imaging

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

PVP:

Portal venous phase

RN:

Regenerative nodule

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Sun Kyung Jeon, Ijin Joo, Jae Seok Bae, Sae-Jin Park & Jeong Min Lee

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Sun Kyung Jeon, Ijin Joo, Jae Seok Bae, Sae-Jin Park & Jeong Min Lee

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Jeong Min Lee

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Correspondence to Ijin Joo.

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Jeon, S.K., Joo, I., Bae, J.S. et al. LI-RADS v2018: how to appropriately use ancillary features in category adjustment from intermediate probability of malignancy (LR-3) to probably HCC (LR-4) on gadoxetic acid–enhanced MRI. Eur Radiol 32, 46–55 (2022). https://doi.org/10.1007/s00330-021-08116-0

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