Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2024; 16(6): 2439-2448
Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2439
Simplified liver imaging reporting and data system for the diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging
Rong Lyu, Wei-Juan Hu, Di Wang, Jiao Wang, Yu-Bing Ye, Ke-Feng Jia
Rong Lyu, Wei-Juan Hu, Di Wang, Jiao Wang, Yu-Bing Ye, Ke-Feng Jia, Department of Radiology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin 300170, China
Co-first authors: Rong Lyu and Wei-Juan Hu.
Author contributions: Lyu R, Hu WJ and Jia KF conceptualized and designed the research; Hu WJ, Wang D and Wang J screened patients and acquired clinical data; Lyu R and Ye YB performed data analysis; Lyu R and Hu WJ wrote the paper; All the authors have read and approved the final manuscript. Lyu R conceptualized and designed the research, performed data analysis and wrote the paper. Hu WJ conceptualized and designed the research, screened patients and acquired clinical data and wrote the paper. Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Supported by The Tianjin Key Medical Discipline (Specialty) Construction Project, No. TJYXZDXK-074C.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Tianjin Third Central Hospital, No. IRB2022-039-01.
Informed consent statement: Informed consent was waived due to the retrospective study design.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ke-Feng Jia, Doctor, Deputy Chief Physician, Department of Radiology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, No. 83 Jintang Road, Hedong District, Tianjin 300170, China. wangzhiwangzhi2000@126.com
Received: December 11, 2023
Revised: February 28, 2024
Accepted: April 11, 2024
Published online: June 15, 2024
Processing time: 186 Days and 17.1 Hours
Abstract
BACKGROUND

The liver imaging reporting and data system (LI-RADS) diagnostic table has 15 cells and is too complex. The diagnostic performance of LI-RADS for hepatocellular carcinoma (HCC) is not satisfactory on gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI).

AIM

To evaluate the ability of the simplified LI-RADS (sLI-RADS) to diagnose HCC on EOB-MRI.

METHODS

A total of 331 patients with 356 hepatic observations were retrospectively analysed. The diagnostic performance of sLI-RADS A-D using a single threshold was evaluated and compared with LI-RADS v2018 to determine the optimal sLI-RADS. The algorithms of sLI-RADS A-D are as follows: The single threshold for sLI-RADS A and B was 10 mm, that is, classified observations ≥ 10mm using an algorithm of 10-19 mm observations (sLI-RADS A) and ≥ 20 mm observations (sLI-RADS B) in the diagnosis table of LI-RADS v2018, respectively, while the classification algorithm remained unchanged for observations < 10 mm; the single threshold for sLI-RADS C and D was 20 mm, that is, for < 20 mm observations, the algorithms for < 10 mm observations (sLI-RADS C)and 10-19 mm observations (sLI-RADS D) were used, respectively, while the algorithm remained unchanged for observations ≥ 20 mm. With hepatobiliary phase (HBP) hypointensity as a major feature (MF), the final sLI-RADS (F-sLI-RADS) was formed according to the optimal sLI-RADS, and its diagnostic performance was evaluated. The times needed to classify the observations according to F-sLI-RADS and LI-RADS v2018 were compared.

RESULTS

The optimal sLI-RADS was sLI-RADS D (with a single threshold of 20 mm), because its sensitivity was greater than that of LI-RADS v2018 (89.8% vs 87.0%, P = 0.031), and its specificity was not lower (89.4% vs 90.1%, P > 0.999). With HBP hypointensity as an MF, the sensitivity of F-sLI-RADS was greater than that of LI-RADS v2018 (93.0% vs 87.0%, P < 0.001) and sLI-RADS D (93.0% vs 89.8%, P = 0.016), without a lower specificity (86.5% vs 90.1%, P = 0.062; 86.5% vs 89.4%, P = 0.125). Compared with that of LI-RADS v2018, the time to classify lesions according to F-sLI-RADS was shorter (51 ± 21 s vs 73 ± 24 s, P < 0.001).

CONCLUSION

The use of sLI-RADS with HBP hypointensity as an MF may improve the sensitivity of HCC diagnosis and reduce lesion classification time.

Keywords: Hepatocellular carcinoma; Magnetic resonance imaging; Liver; Diagnosis; Contrast agent

Core Tip: This retrospective study included 356 hepatic observations. A single threshold (observation size) was used to simplify the liver imaging reporting and data system (LI-RADS) diagnostic table, and hepatobiliary phase hypointensity was added as a major feature to improve the sensitivity of LI-RADS for the diagnosis of hepatocellular carcinoma and shorten the observation classification time.