Simplified liver imaging reporting and data system for the diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging

Table 1 Clinicopathologic characteristics of the patients and hepatic observations, n (%)

Characteristic	Value
Patient (n = 331)
Mean age (yr)1	57.5 ± 10.9
Sex
Male	236 (71.3)
Female	95 (28.7)
Cause of liver disease
Hepatitis B virus	244 (73.7)
Hepatitis C virus	51 (15.4)
Hepatitis B and C virus	9 (2.7)
Alcohol	10 (3.0)
Autoimmune	4 (1.2)
NASH	3 (0.9)
Cirrhosis of unknown cause	10 (3.0)
Number of observations per patient
1	309 (93.4)
2	19 (5.7)
3	3 (0.9)
Observation (n = 356)
Size (mm)1
Overall	31.5 ± 25.9
HCC	35.8 ± 27.1
Non-HCC malignancy	43.2 ± 27.8
Benign lesion	21.0 ± 19.2
Final diagnosis
HCC	215 (60.4)
Non-HCC malignancy	25 (7.0)
ICC	7 (2.0)
CHC	8 (2.2)
Metastasis	5 (1.4)
Sarcomatoid carcinoma	4 (1.1)
Neuroendocrine carcinoma	1 (0.3)
Benign lesion	116 (32.6)
Haemangioma	14 (3.9)
DN	24 (6.7)
RN	42 (11.8)
FNH-like	17 (4.8)
Adenoma or adenomatoid hyperplasia	5 (1.4)
Abscess	2 (0.6)
Angiomyolipoma	2 (0.6)
Epithelioid angiomyolipoma	3 (0.8)
Abnormal perfusion	7 (2.0)
Standard reference of diagnosis
Pathologic diagnosis	286 (80.3)
Typical imaging features and follow-up	70 (19.7)
The time of follow-up (months)1	32.3 ± 13.5

¹Data are presented as the mean ± SD.

Unless stated otherwise, data are presented as the number of patients or observations with the percentage in parentheses. NASH: Nonalcoholic steatohepatitis; HCC: Hepatocellular carcinoma; ICC: Intrahepatic cholangiocarcinoma; CHC: Combined hepatocellular cholangiocarcinoma; DN: Dysplastic nodule; RN: Regenerative nodule; FNH: Focal nodular hyperplasia.

Table 2 The observation categories according to the liver imaging reporting and data system

LI-RADS category	LI-RADS v2018		sLI-RADS A		sLI-RADS B		sLI-RADS C		sLI-RADS D		F-sLI-RADS
	HCC	non-HCC	HCC	non-HCC	HCC	non-HCC	HCC	non-HCC	HCC	non-HCC	HCC	non-HCC
1	0	42	0	42	0	42	0	42	0	42	0	42
2	1	38	1	38	1	38	1	38	1	38	1	38
3	11	13	16	28	1	2	11	13	11	13	7	13
4	15	19	21	4	22	26	64	25	9	18	6	14
5	187	14	176	14	190	18	138	8	193	15	200	19
M	1	15	1	15	1	15	1	15	1	15	1	15
Total	215	141	215	141	215	141	215	141	215	141	215	141

M indicates liver imaging reporting and data system M category (probably or definitely malignant but not hepatocellular carcinoma specific). HCC: Hepatocellular carcinoma; LI-RADS: Liver imaging reporting and data system; sLI-RADS: Simplified liver imaging reporting and data system; F-sLI-RADS: Final simplified liver imaging reporting and data system.

Table 3 Diagnostic performance of the liver imaging reporting and data system for hepatocellular carcinoma, %

	Sensitivity	Specificity	PPV	NPV	Accuracy	Youden
LI-RADS v2018	87.0	90.1	93.0	81.9	88.2	0.770
sLI-RADS A	81.9	90.1	92.6	76.5	85.1	0.719
sLI-RADS B	88.4	87.2	91.3	83.1	87.9	0.756
sLI-RADS C	64.2	93.6	93.9	63.2	75.8	0.578
sLI-RADS D	89.8	89.4	92.8	85.1	89.6	0.791
F-sLI-RADS	93.0	86.5	91.3	89.1	90.4	0.795
aPvalue	0.001	> 0.999	—	—	0.001	—
bPvalue	0.250	0.125	—	—	> 0.999	—
cPvalue	< 0.001	0.031	—	—	< 0.001	—
dPvalue	0.031	> 0.999	—	—	0.062	—
ePvalue	< 0.001	0.062	—	—	0.008	—
fPvalue	0.016	0.125	—	—	0.250	—

^aP value is the P value of the comparison results of the diagnostic performance between simplified liver imaging reporting and data system (sLI-RADS) A and liver imaging reporting and data system (LI-RADS) v2018, respectively.

^bP value is the P value of the comparison results of the diagnostic performance between sLI-RADS B and LI-RADS v2018, respectively.

^cP value is the P value of the comparison results of the diagnostic performance between sLI-RADS C and LI-RADS v2018, respectively.

^dP value is the P value of the comparison results of the diagnostic performance between sLI-RADS D and LI-RADS v2018, respectively.

^eP value is the P value of the comparison results of the diagnostic performance between sLI-RADS E and LI-RADS v2018, respectively.

^fP value is the P value of the comparison results of the diagnostic performance between F-sLI-RADS and sLI-RADS D.

“—”: Indicates no data. PPV: Positive predictive value; NPV: Negative predictive value; LI-RADS: Liver imaging reporting and data system; sLI-RADS: Simplified liver imaging reporting and data system; F-sLI-RADS: Final simplified liver imaging reporting and data system.