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Huang Z, Zhu RH, Li SS, Luo HC, Li KY. CEUS in prediction of early recurrence of hepatocellular carcinoma after curative resection and to stratify the risk of early recurrence: a retrospective observational study. Abdom Radiol (NY) 2024; 49:1870-1880. [PMID: 38557770 DOI: 10.1007/s00261-024-04252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Early recurrence (ER) after surgery is related to early death in patients with hepatocellular carcinoma (HCC) after radical resection. To explore the role of preoperative contrast-enhanced ultrasound (CEUS) in predicting ER of HCC after curative resection and to stratify the risk of ER. MATERIALS AND METHODS This study evaluated consecutive 556 patients with HCC who were examined by CEUS during the 2 weeks before curative resection between January 2011 and December 2018. ER was defined as intrahepatic and/or extrahepatic recurrence within 2 year after resection of HCC. Univariate and logistic regression analyses were performed to identify independent risk factors for ER after surgical resection of HCC. Recurrence-free time (RFS) rates were analyzed and compared by log-rank test. RESULTS ER occurred in 307 (55.2%) of the 556 patients. Univariate and multivariate analyses revealed that a tumor size ≥ 30 mm and satellite nodules seen on CEUS, DL(deep learning) radiomics reoccurrence score based on the frame of image with the maximum intensity of CEUS and an elevated alpha-fetoprotein level were significantly associated with ER (P < .05). Based on the number of predictors present, patients with CEUS LR-5 HCC were stratified into three risk subgroups: risk group 3 (high-risk patients, 4 predictors), risk group 2 (medium-risk patients, 2-3 predictors), and risk group 1 (low-risk patients, 0-1 predictor). The 2-year RFS rate was 19.4% in risk group 3, 40.9% in risk group 2, and 48.1% in risk group 1; the corresponding mean RFS times were 14.0 ± 2.9 months, 43.7 ± 6.6 months, and 55.5 ± 2.8 months, respectively (P < .001). CONCLUSIONS Tumor size ≥ 30 mm and satellite nodules seen on CEUS, DL radiomics reoccurrence score based on the frame of image with the maximum intensity of CEUS and an elevated alpha-fetoprotein level can predict ER of HCC.
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China
| | - Rong-Hua Zhu
- Institute of Hepato-Pancreato-Bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China
| | - Shan-Shan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China
| | - Hong-Chang Luo
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China.
| | - Kai-Yan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China.
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Castagnoli F, Faletti R, Inchingolo R, Villanacci A, Ruggeri V, Zacà D, Koh DM, Grazioli L. Intra-patient and inter-observer image quality analysis in liver MRI study with gadoxetic acid using two different multi-arterial phase techniques. Br J Radiol 2024; 97:868-873. [PMID: 38400772 PMCID: PMC11027306 DOI: 10.1093/bjr/tqae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
PURPOSE To evaluate intra-patient and interobserver agreement in patients who underwent liver MRI with gadoxetic acid using two different multi-arterial phase (AP) techniques. METHODS A total of 154 prospectively enrolled patients underwent clinical gadoxetic acid-enhanced liver MRI twice within 12 months, using two different multi-arterial algorithms: CAIPIRINHA-VIBE and TWIST-VIBE. For every patient, breath-holding time, body mass index, sex, age were recorded. The phase without contrast media and the APs were independently evaluated by two radiologists who quantified Gibbs artefacts, noise, respiratory motion artefacts, and general image quality. Presence or absence of Gibbs artefacts and noise was compared by the McNemar's test. Respiratory motion artefacts and image quality scores were compared using Wilcoxon signed rank test. Interobserver agreement was assessed by Cohen kappa statistics. RESULTS Compared with TWIST-VIBE, CAIPIRINHA-VIBE images had better scores for every parameter except higher noise score. Triple APs were always acquired with TWIST-VIBE but failed in 37% using CAIPIRINHA-VIBE: 11% have only one AP, 26% have two. Breath-holding time was the only parameter that influenced the success of multi-arterial techniques. TWIST-VIBE images had worst score for Gibbs and respiratory motion artefacts but lower noise score. CONCLUSION CAIPIRINHA-VIBE images were always diagnostic, but with a failure of triple-AP in 37%. TWIST-VIBE was successful in obtaining three APs in all patients. Breath-holding time is the only parameter which can influence the preliminary choice between CAIPIRINHA-VIBE and TWIST-VIBE algorithm. ADVANCES IN KNOWLEDGE If the patient is expected to perform good breath-holds, TWIST-VIBE is preferable; otherwise, CAIPIRINHA-VIBE is more appropriate.
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Affiliation(s)
- Francesca Castagnoli
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton SM2 5NG, United Kingdom
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10124, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | | | - Valeria Ruggeri
- Department of I Radiology, ASST Spedali Civili, Brescia 25123, Italy
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton SM2 5PT, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton SM2 5NG, United Kingdom
| | - Luigi Grazioli
- Department of I Radiology, ASST Spedali Civili, Brescia 25123, Italy
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Ma Y, Gong Y, Qiu Q, Ma C, Yu S. Research on multi-model imaging machine learning for distinguishing early hepatocellular carcinoma. BMC Cancer 2024; 24:363. [PMID: 38515051 PMCID: PMC10956394 DOI: 10.1186/s12885-024-12109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To investigate the value of differential diagnosis of hepatocellular carcinoma (HCC) and non-hepatocellular carcinoma (non-HCC) based on CT and MR multiphase radiomics combined with different machine learning models and compare the diagnostic efficacy between different radiomics models. BACKGROUND Primary liver cancer is one of the most common clinical malignancies, hepatocellular carcinoma (HCC) is the most common subtype of primary liver cancer, accounting for approximately 90% of cases. A clear diagnosis of HCC is important for the individualized treatment of patients with HCC. However, more sophisticated diagnostic modalities need to be explored. METHODS This retrospective study included 211 patients with liver lesions: 97 HCC and 124 non-hepatocellular carcinoma (non-HCC) who underwent CT and MRI. Imaging data were used to obtain imaging features of lesions and radiomics regions of interest (ROI). The extracted imaging features were combined to construct different radiomics models. The clinical data and imaging features were then combined with radiomics features to construct the combined models. Support Vector Machine (SVM), K-nearest Neighbor (KNN), RandomForest (RF), eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Multilayer Perceptron (MLP) six machine learning models were used for training. Five-fold cross-validation was used to train the models, and ROC curves were used to analyze the diagnostic efficacy of each model and calculate the accuracy rate. Model training and efficacy test were performed as before. RESULTS Statistical analysis showed that some clinical data (gender and concomitant cirrhosis) and imaging features (presence of envelope, marked enhancement in the arterial phase, rapid contouring in the portal phase, uniform density/signal and concomitant steatosis) were statistical differences (P < 0.001). The results of machine learning models showed that KNN had the best diagnostic efficacy. The results of the combined model showed that SVM had the best diagnostic efficacy, indicating that the combined model (accuracy 0.824) had better diagnostic efficacy than the radiomics-only model. CONCLUSIONS Our results demonstrate that the radiomic features of CT and MRI combined with machine learning models enable differential diagnosis of HCC and non-HCC (malignant, benign). The diagnostic model with dual radiomic had better diagnostic efficacy. The combined model was superior to the radiomic model alone.
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Affiliation(s)
- Ya Ma
- Department of Graduate, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Physics, Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Shandong Province, 250117, Jinan, China
| | - Yue Gong
- Department of Graduate, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Physics, Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Shandong Province, 250117, Jinan, China
| | - QingTao Qiu
- Department of Radiation Physics, Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Shandong Province, 250117, Jinan, China
| | - Changsheng Ma
- Department of Radiation Physics, Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Shandong Province, 250117, Jinan, China.
| | - Shuang Yu
- Department of Hematology, Qilu Hospital of Shandong University, 250012, Jinan, China.
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Association of Multi-Phasic MR-Based Radiomic and Dosimetric Features with Treatment Response in Unresectable Hepatocellular Carcinoma Patients following Novel Sequential TACE-SBRT-Immunotherapy. Cancers (Basel) 2023; 15:cancers15041105. [PMID: 36831445 PMCID: PMC9954441 DOI: 10.3390/cancers15041105] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
This study aims to investigate the association of pre-treatment multi-phasic MR-based radiomics and dosimetric features with treatment response to a novel sequential trans-arterial chemoembolization (TACE) plus stereotactic body radiotherapy (SBRT) plus immunotherapy regimen in unresectable Hepatocellular Carcinoma (HCC) sub-population. Twenty-six patients with unresectable HCC were retrospectively analyzed. Radiomic features were extracted from 42 lesions on arterial phase (AP) and portal-venous phase (PVP) MR images. Delta-phase (DeltaP) radiomic features were calculated as AP-to-PVP ratio. Dosimetric data of the tumor was extracted from dose-volume-histograms. A two-sided independent Mann-Whitney U test was used to assess the clinical association of each feature, and the classification performance of each significant independent feature was assessed using logistic regression. For the 3-month timepoint, four DeltaP-derived radiomics that characterize the temporal change in intratumoral randomness and uniformity were the only contributors to the treatment response association (p-value = 0.038-0.063, AUC = 0.690-0.766). For the 6-month timepoint, DeltaP-derived radiomic features (n = 4) maintained strong clinical associations with the treatment response (p-value = 0.047-0.070, AUC = 0.699-0.788), additional AP-derived radiomic features (n = 4) that reflect baseline tumoral arterial-enhanced signal pattern and tumor morphology (n = 1) that denotes initial tumor burden were shown to have strong associations with treatment response (p-value = 0.028-0.074, AUC = 0.719-0.773). This pilot study successfully demonstrated associations of pre-treatment multi-phasic MR-based radiomics with tumor response to the novel treatment regimen.
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Huang Z, Zhou P, Li S, Li K. Evaluation of contrast-enhanced ultrasound LI-RADS version 2017: application on 271 liver nodules in individuals with non-alcoholic steatohepatitis. Eur Radiol 2022; 32:7146-7154. [PMID: 35639147 DOI: 10.1007/s00330-022-08872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/30/2022] [Accepted: 05/12/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) version 2017 in a population with non-alcoholic steatohepatitis (NASH). METHODS Between January 2013 and December 2020, consecutive patients diagnosed with NASH with untreated liver nodules were enrolled in this retrospective study. A prospective evaluation was performed between January 2021 and August 2021 as a validation set. Diagnostic performance was assessed. RESULTS We included 217 nodules in 211 patients (mean age, 49.7 ± 21.7 years; male, 156) in the retrospective study. The positive predictive value (PPV) of CEUS LR-5 in the diagnosis of hepatocellular carcinoma (HCC) was 70.8% (56/79). In total, 28 of 217 (12.9%) nodules were classified as LR-M, of which 12 showed arterial phase hyper-enhancement, early washout, and absence of a punched-out appearance within 5 min; 10 of the 12 (83%) were HCC. When these nodules were reclassified as LR-5, the specificity of LR-M as a predictor of non-HCC malignancy increased from 91.0 (181/199) to 96.5% (192/199) (p = .023). Despite the reclassification, LR-5 specificity and PPV remained high (80.6% and 72.5%, respectively). Following reclassification, LR-M specificity increased from 90.0 (45/50) to 100% (50/50) (p = .022) in the validation set. CONCLUSION CEUS LI-RADS category LR-5 is effective in predicting the presence of HCC. In NASH patients, diagnostic performance can be further improved by reclassifying LR-M nodules with arterial phase hyper-enhancement, early washout, and punched-out appearance as LR-5. KEY POINTS • The LI-RADS classification of CEUS has a high application value for differentiation of HCC in NASH patients. • When LR-M nodules with arterial phase hyperenhancement and early washout but not punched-out appearance at < 5 min are reclassified as LR-5; the modification of LI-RADS has a better performance. • The PPV of modified LR-5 in the non-cirrhotic group was better than that of LR-5. The PPV of modified CEUS LR-5 in the non-cirrhotic group was comparable to that in the cirrhotic group (p both = 0.065).
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China
| | - PingPing Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China
| | - ShanShan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan City, 430030, Hubei Province, China.
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Yoo J, Lee JM, Yoon JH, Joo I, Lee ES, Jeon SK, Jang S. Comparison of low kVp CT and dual-energy CT for the evaluation of hypervascular hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:3217-3226. [PMID: 33713160 DOI: 10.1007/s00261-020-02888-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare lesion conspicuity and image quality of arterial phase images obtained from low kVp (90-kVp) and dual-energy (DE) scans for the evaluation of hypervascular hepatocellular carcinoma (HCC). METHODS This retrospective study included 229 patients with HCC who underwent either 90 kVp (n = 106) or DE scan (80- and 150-kVp with a tin filter) (n = 123) during the arterial phase. DE scans were reconstructed into a linearly blended image with a mixed ratio of 0.6 (60% 80kVp and 40% 150 kVp) and post-processed for 40 keV and 50 keV images. The contrast-to-noise ratio (CNR) of HCC to the liver and image noise was measured. Lesion conspicuity, liver parenchymal image quality, and overall image preference were assessed qualitatively by three independent radiologists. RESULTS DE 40 keV images had the highest CNR of HCC, and DE blended images had the lowest image noise among four image sets (p = 0.01 and p < 0.001, respectively). There was no significant difference in mean volume CT dose index and dose-length product between DE and low kVp scan (ps > 0.05). For qualitative analyses, DE blended images had the highest scores for image quality and overall image preference (ps < 0.001). CONCLUSION At an equal radiation dose, DE 40 keV showed higher CNR of HCC and DE blended image showed higher image quality and image preference compared with low kVp CT.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Korea.
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Siwon Jang
- Department of Radiology, Seoul National University Boramae Hospital, Seoul, Korea
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Ojeda PI, Hannan LM, Mieloszyk RJ, Hall CS, Mileto A, Harris WP, Park JO, Baheti AD, Hippe DS, Bhargava P. Is There a Difference Between LI-RADS 3 to LI-RADS 5 Progression Assessment Using CT Versus MR? A Retrospective, Single-Center, Longitudinal Study of Patients Who Underwent 5082 Radiologic Examinations for Surveillance of Hepatocellular Carcinoma Over a 43-Month Period. Curr Probl Diagn Radiol 2021; 51:176-180. [PMID: 33980417 DOI: 10.1067/j.cpradiol.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Liver Imaging Reporting and Data System (LI-RADS) has been widely applied to CT and MR liver observations in patients at high-risk for hepatocellular carcinoma (HCC). We investigated the impact of CT vs MR in upgrading LI-RADS 3 to LI-RADS 5 observations using a large cohort of high-risk patients. METHODS We performed a retrospective, longitudinal study of CT and MR radiographic reports (June 2013 - February 2017) with an assigned LI-RADS category. A final population of 757 individual scans and 212 high-risk patients had at least one LI-RADS 3 observation. Differences in observation time to progression between modalities were determined using uni- and multivariable analysis. RESULTS Of the 212 patients with a LI-RADS 3 observation, 52 (25%) had progression to LI-RADS 5. Tp ranged from 64 - 818 days (median: 196 days). One hundred and three patients (49%) had MR and 109 patients (51%) had CT as their index study. Twenty-four patients with an MR index exam progressed to LI-RADS 5 during the follow-up interval, with progression rates of 22% (CI:13%-30%) at 1 year and 29% (CI:17%-40%) at 2 years. Twenty-eight patients with a CT index exam progressed to LI-RADS 5 during follow-up, with progression rates of 26% (CI:16%-35%) at 1 year and 31% (CI:19%-41%) at 2 years. Progression rates were not significantly different between patients whose LI-RADS 3 observation was initially diagnosed on MR vs CT (HR: 0.81, P = 0.44). DISCUSSION MR and CT modalities are comparable for demonstrating progression from LI-RADS 3 to 5 for high risk patients.
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Affiliation(s)
- Patricia I Ojeda
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Lindsay M Hannan
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Rebecca J Mieloszyk
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Microsoft Research, Redmond, WA
| | - Christopher S Hall
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Achille Mileto
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - William P Harris
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - James O Park
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Akshay D Baheti
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Department of Radiology, Tata Memorial Center, Mumbai, India; Department of Radiology, Homi Bhabha National Institute, Mumbai, India
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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Tang A, Abukasm K, Moura Cunha G, Song B, Wang J, Wagner M, Dietrich CF, Brancatelli G, Ueda K, Choi JY, Aguirre D, Sirlin CB. Imaging of hepatocellular carcinoma: a pilot international survey. Abdom Radiol (NY) 2021; 46:205-215. [PMID: 32488557 DOI: 10.1007/s00261-020-02598-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To perform an international survey on current practices in imaging-based surveillance, diagnosis, staging, and assessment of treatment response for HCC. MATERIALS AND METHODS Three themes were covered in this international survey: demographics of respondents and liver imaging expertise; imaging practices for screening, surveillance, diagnosis, staging, and assessment of treatment response for HCC; and diagnostic imaging systems used. Descriptive summaries were created. RESULTS Of 151 respondents, 22.5% were from Asia, 6.0% from Europe, 19.9% from North America, 26.5% from South America, and 25.2% from Australasia; 57.0% respondents worked in academic and 34.4% in private or mixed settings. Non-contrast ultrasound was most commonly used for screening and surveillance of HCC (90.7%), and multiphase computed tomography was used for diagnosis (96.0%). Extracellular contrast agents (69.5%) were the most commonly used MRI contrast agents and Lumason/SonoVue (31.1%) is the most commonly used contrast-enhanced ultrasound contrast agent. A majority (94.0%) of respondents use ancillary imaging features for assessment of liver lesions in at-risk patients. Usage of diagnostic imaging systems for HCC varied by region. RECIST or mRECIST criteria were most commonly used for assessing HCC treatment response (48.3%). Most respondents agreed that a standardized classification for the diagnosis of HCC is needed (68.9%) and that an atlas and lexicon would help improve inter-reader agreement (71.5%). CONCLUSION Practices and recommendations for imaging of HCC vary between geographical regions. Future efforts to develop a unified system should address regional differences and potential barriers for adoption of a standardized diagnostic system for HCC.
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Affiliation(s)
- An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, Québec, H2X 3J4, Canada.
- Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
| | - Karma Abukasm
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Centre Hospitalier de L'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, Québec, H2X 3J4, Canada
| | - Guilherme Moura Cunha
- Clínica de Diagnóstico Por Imagem (CDPI) - DASA, Rio de Janeiro, Brazil
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Wang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Mathilde Wagner
- Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France
| | | | - Giuseppe Brancatelli
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata (BIND), University Hospital of Palermo, Palermo, Italy
| | - Kazuhiko Ueda
- Department of Diagnostic Radiology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Claude B Sirlin
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
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Kang HJ, Lee JM, Yoon JH, Han JK. Role of Contrast-Enhanced Ultrasound as a Second-Line Diagnostic Modality in Noninvasive Diagnostic Algorithms for Hepatocellular Carcinoma. Korean J Radiol 2020; 22:354-365. [PMID: 33236540 PMCID: PMC7909851 DOI: 10.3348/kjr.2020.0973] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. MATERIALS AND METHODS We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar's test. RESULTS The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. CONCLUSION The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.
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Affiliation(s)
- Hyo Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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10
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Alenazi AO, Elsayes KM, Marks RM, Yacoub JH, Hecht EM, Chernyak V, Krishna S, Surabhi V, Lee JT, Ash R, Cruite I, Kielar AZ. Clinicians and surgeon survey regarding current and future versions of CT/MRI LI-RADS. Abdom Radiol (NY) 2020; 45:2603-2611. [PMID: 32342150 DOI: 10.1007/s00261-020-02544-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine preferences of clinicians and surgeons regarding radiology reporting of liver observations in patients at risk for hepatocellular carcinoma (HCC). METHODS Members of the American College of Radiology Liver Imaging and Data Reporting System (LI-RADS) Outreach & Education Group (30 members) as well as Society of Abdominal Radiology Disease-Focused Panel on HCC diagnosis (27 members) created and distributed an 18-question survey to clinicians and surgeons, with focus on preferences regarding radiology reporting of liver observations in patients. The survey questions were directed to physician demographics, current use of LI-RADS by their local radiologists, their opinions about current LI-RADS and potential improvements. RESULTS A total of 152 physicians responded, 66.4% (101/152) from North America, including 42 surgeons, 81 physicians and 29 interventional radiologists. Participants were predominantly from academic centers 83% (126/152), while 13.8% (21/152) worked in private/community centers and 3.2% (5/152) worked in a hybrid practice. Almost 90% (136/152) of participants preferred the use of LI-RADS (compared to nothing or other standardized reporting systems; OPTN and AASLD) to communicate liver-related observations. However, only 28.5% (43/152) of participants input was sought at the time of implementing LI-RADS in their institutions. Fifty-eight percent (88/152) of all participants found standardized LI-RADS management recommendations in radiology reports to be clinically helpful. However, a subgroup analysis of surgeons in academic centers showed that 61.8% (21/34) prefer not to receive standardized LI-RADS recommendations. CONCLUSIONS Most participants preferred the use LI-RADS in reporting CT and MRI examination. When considering inclusion of management recommendations, radiologists should consult with their referring physicians, as preference may differ.
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11
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Kim JH, Joo I, Lee JM. Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging. Korean J Radiol 2020; 20:1019-1041. [PMID: 31270973 PMCID: PMC6609440 DOI: 10.3348/kjr.2018.0636] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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12
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Kim TH, Yoon JH, Lee JM. Emerging Role of Hepatobiliary Magnetic Resonance Contrast Media and Contrast-Enhanced Ultrasound for Noninvasive Diagnosis of Hepatocellular Carcinoma: Emphasis on Recent Updates in Major Guidelines. Korean J Radiol 2020; 20:863-879. [PMID: 31132813 PMCID: PMC6536788 DOI: 10.3348/kjr.2018.0450] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 02/03/2019] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) can be noninvasively diagnosed on the basis of its characteristic imaging findings of arterial phase enhancement and portal/delayed “washout” on computed tomography (CT) and magnetic resonance imaging (MRI) in cirrhotic patients. However, different specific diagnostic criteria have been proposed by several countries and major academic societies. In 2018, major guideline updates were proposed by the Association for the Study of Liver Diseases, European Association for the Study of the Liver (EASL), Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) of Korea. In addition to dynamic CT and MRI using extracellular contrast media, these new guidelines now include magnetic resonance imaging (MRI) using hepatobiliary contrast media as the first-line diagnostic test, while the KLCA-NCC and EASL guidelines also include contrast-enhanced ultrasound (CEUS) as the second-line diagnostic test. Therefore, hepatobiliary MR contrast media and CEUS will be increasingly used for the noninvasive diagnosis and staging of HCC. In this review, we discuss the emerging role of hepatobiliary phase MRI and CEUS for the diagnosis of HCC and also review the changes in the HCC diagnostic criteria in major guidelines, including the KLCA-NCC practice guidelines version 2018. In addition, we aimed to pay particular attention to some remaining issues in the noninvasive diagnosis of HCC.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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13
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Alenezi AO, Krishna S, Mendiratta-Lala M, Kielar AZ. Imaging and Management of Liver Cancer. Semin Ultrasound CT MR 2020; 41:122-138. [PMID: 32446427 DOI: 10.1053/j.sult.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Imaging of primary hepatic neoplasms in patients at risk for hepatocellular carcinoma (HCC) and in patients with otherwise normal livers relies on proper multiphase image acquisition technique, with emphasis on a high-quality, late arterial phase, using either CT or MRI for accurate image interpretation. The introduction of liver imaging reporting and data system in 2011, with subsequent multiple updates, the most recent in 2018, has provided standardization of image interpretation, reporting and management recommendations for liver observations in patients at risk for HCC. This review article will emphasize key points of imaging primary liver tumors with emphasis on liver imaging reporting and data system, including strengths of this system. We will also review imaging of less common primary liver tumors such as cholangiocarcinoma and angiosarcomas. Imaging pitfall associated with primary liver malignancies will be demonstrated as well as ways to mitigate them. Finally, imaging and reporting of findings following locoregional treatment of HCC will be reviewed.
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Affiliation(s)
- Abdullah O Alenezi
- Joint Department of Medical Imaging (JDMI), University of Toronto, Toronto, Ontario, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging (JDMI), University of Toronto, Toronto, Ontario, Canada
| | | | - Ania Z Kielar
- University of Toronto, University of Ottawa, Ottawa, Canada.
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14
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Pereira RDCR, Heming CAM, Tejo TR, de Oliveira TCL, da Silva RDSU, Parente DB. Use of the LI-RADS classification in patients with cirrhosis due to infection with hepatitis B, C, or D, or infected with hepatitis B and D. Radiol Bras 2020; 53:14-20. [PMID: 32313331 PMCID: PMC7159051 DOI: 10.1590/0100-3984.2018.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate liver lesions, in accordance with the LI-RADS classification, using contrast-enhanced multiphase dynamic computed tomography in patients with hepatitis B, coinfected or not with hepatitis D, or with chronic hepatitis C, as well as to determine the level of agreement between radiologists. Materials and Methods We evaluated 38 patients with hepatitis B, coinfected or not with hepatitis D, or with chronic hepatitis C, all of whom underwent contrast-enhanced multiphase dynamic computed tomography. For each examination, two radiologists selected up to three hepatic lesions, categorizing them in accordance with the LI-RADS classification and evaluating signs of chronic liver disease and portal hypertension. To determine the level of agreement between radiologists, we calculated the kappa statistic (κ) . Results Radiologist 1 and radiologist 2 selected 56 and 48 liver lesions, respectively. According to radiologist 1 and radiologist 2, respectively, 27 (71%) and 23 (61%) of the 38 patients had at least one liver lesion; 13 (34%) and 12 (32%) had a LI-RADS 5 lesion (κ = 0.821); 19 (50%) and 16 (42%) had a hypervascular lesion (κ = 0.668); and 30 (79%) and 24 (63%) had splenomegaly (κ = 0.503). Both radiologists identified chronic liver disease in 31 (82%) of the patients (κ = 1.00). Conclusion Lesions categorized as LI-RADS 5 were detected in approximately 32% of the patients, with almost perfect agreement between the radiologists. The level of agreement was substantial or moderate for the other LI-RADS categories.
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Affiliation(s)
| | | | | | | | | | - Daniella Braz Parente
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
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15
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Liver Imaging Reporting and Data System Version 2018: What Radiologists Need to Know. J Comput Assist Tomogr 2020; 44:168-177. [PMID: 32195795 DOI: 10.1097/rct.0000000000000995] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this article, we aim to review Liver Imaging Reporting and Data System version 18 (LI-RADS v2018). Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Liver Imaging Reporting and Data System developed for standardizing interpreting, reporting, and data collection of HCC describes 5 major features for accurate HCC diagnosis and several ancillary features, some favoring HCC in particular or malignancy in general and others favoring benignity. Untreated hepatic lesions LI-RADS affords 8 unique categories based on imaging appearance on computed tomography and magnetic resonance imaging, which indicate the possibility of HCC or malignancy with or without tumor in vein. Furthermore, LI-RADS defines 4 treatment response categories for treated HCCs after different locoregional therapy. These continuous recent updates on LI-RADS improve the communication between the radiologists and the clinicians for better management and patient outcome.
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16
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Miranda Magalhaes Santos JM, Clemente Oliveira B, Araujo-Filho JDAB, Assuncao-Jr AN, de M Machado FA, Carlos Tavares Rocha C, Horvat JV, Menezes MR, Horvat N. State-of-the-art in radiomics of hepatocellular carcinoma: a review of basic principles, applications, and limitations. Abdom Radiol (NY) 2020; 45:342-353. [PMID: 31707435 DOI: 10.1007/s00261-019-02299-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radiomics is a new field in medical imaging with the potential of changing medical practice. Radiomics is characterized by the extraction of several quantitative imaging features which are not visible to the naked eye from conventional imaging modalities, and its correlation with specific relevant clinical endpoints, such as pathology, therapeutic response, and survival. Several studies have evaluated the use of radiomics in patients with hepatocellular carcinoma (HCC) with encouraging results, particularly in the pretreatment prediction of tumor biological characteristics, risk of recurrence, and survival. In spite of this, there are limitations and challenges to be overcome before the implementation of radiomics into clinical routine. In this article, we will review the concepts of radiomics and their current potential applications in patients with HCC. It is important that the multidisciplinary team involved in the treatment of patients with HCC be aware of the basic principles, benefits, and limitations of radiomics in order to achieve a balanced interpretation of the results toward a personalized medicine.
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Affiliation(s)
| | - Brunna Clemente Oliveira
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
- Department of Radiology, Hospital Samaritano, São Paulo, Brazil
| | | | | | | | | | - Joao Vicente Horvat
- Department of Radiology, University of São Paulo, São Paulo, Brazil
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Marcos Roberto Menezes
- Department of Radiology, University of São Paulo, São Paulo, Brazil
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Natally Horvat
- Department of Radiology, University of São Paulo, São Paulo, Brazil.
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil.
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17
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Characterization of liver nodules in patients with chronic liver disease by MRI: performance of the Liver Imaging Reporting and Data System (LI-RADS v.2018) scale and its comparison with the Likert scale. Radiol Med 2019; 125:15-23. [PMID: 31587182 DOI: 10.1007/s11547-019-01092-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 09/25/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the performance of the LI-RADS v.2018 scale by comparing it with the Likert scale, in the characterization of liver lesions. METHODS A total of 39 patients with chronic liver disease underwent MR examination for characterization of 44 liver lesions. Images were independently analyzed by two radiologists using the LI-RADS scale and by another two radiologists using the Likert scale. The reference standard used was either histopathological evaluation or a 4-year MRI follow-up. Receiver operating characteristic analysis was performed. RESULTS The LI-RADS scale obtained an accuracy of 80%, a sensitivity of 72%, a specificity of 93%, a positive predictive value (PPV) of 93% and a negative predictive value (NPV) of 70%, while the Likert scale achieved an accuracy of 79%, a sensitivity of 73%, a specificity of 87%, a PPV of 89% and a NPV of 70%. The area under the curve (AUC) was 85% for the LI-RADS scale and 83% for the Likert scale. The inter-observer agreement was strong (k = 0.89) between the LI-RADS evaluators and moderate (k = 0.69) between the Likert evaluators. CONCLUSIONS There was no statistically significant difference between the performances of the two scales; nevertheless, we suggest that the LI-RADS scale be used, as it appeared more objective and consistent.
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18
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The utility of diffusion-weighted imaging in improving the sensitivity of LI-RADS classification of small hepatic observations suspected of malignancy. Abdom Radiol (NY) 2019; 44:1773-1784. [PMID: 30603882 DOI: 10.1007/s00261-018-01887-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We investigated the added value of diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) in the categorization of small hepatic observation (≤ 20 mm) detected in patients with chronic liver disease in reference to LI-RADS (liver imaging reporting and data system) classification system. METHODS We prospectively evaluated 165 patients with chronic liver disease with small hepatic observations (≤ 20 mm) which were previously categorized as LI-RADS grade 3-5 on dynamic contrast-enhanced CT (DCE-CT). All patients were submitted to a functional MRI including DCE and DWI. Using LI-RADS v2017, two radiologists independently evaluated the observations and assigned a LI-RADS category to each observation using DCE-MRI alone and combined DCE-MRI and DWI/ADC. In the combined technique, the radiologists assigned a LI-RADS category based on a modified LI-RADS criteria in which restricted diffusion on DWI was considered a major feature of HCC. We evaluated the inter-reader agreement with Kappa statistics and compared the diagnostic performance of the LI-RADS with two imaging techniques by Fisher's exact test using histopathology as the reference standard. RESULTS Combined technique in LI-RADS yielded better sensitivities (reader 1, 97% [65/67]; reader 2, 95.5% [64/67]) for HCC diagnosis than DCE-MRI alone (reader 1, 80.6% [54/67], p = 0.005; reader 2, 83.6% [56/67], p = 0.04). The specificities were insignificantly lower in combined technique (reader 1, 88.4% [107/121]; reader 2, 77.7% [94/121]) than in DCE-MRI alone (reader 1, 90.9% [110/121], p = 0.67; reader 2, 79.3% [96/121], p = 0.88). The inter-reader agreement of the LI-RADS scores between combined technique and DCE-MRI was good (κ = 0.765). CONCLUSION The use of DWI/ADC as an additional major criterion, improved the sensitivity of LI-RADS in the diagnosis of HCC while keeping high specificity.
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19
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Navin PJ, Venkatesh SK. Hepatocellular Carcinoma: State of the Art Imaging and Recent Advances. J Clin Transl Hepatol 2019; 7:72-85. [PMID: 30944823 PMCID: PMC6441649 DOI: 10.14218/jcth.2018.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing, with this trend expected to continue to the year 2030. Hepatocarcinogenesis follows a predictable course, which makes adequate identification and surveillance of at-risk individuals central to a successful outcome. Moreover, imaging is central to this surveillance, and ultimately to diagnosis and management. Many liver study groups throughout Asia, North America and Europe advocate a surveillance program for at-risk individuals to allow early identification of HCC. Ultrasound is the most commonly utilized imaging modality. Many societies offer guidelines on how to diagnose HCC. The Liver Image Reporting and Data System (LIRADS) was introduced to standardize the acquisition, interpretation, reporting and data collection of HCC cases. The LIRADS advocates diagnosis using multiphase computed tomography or magnetic resonance imaging (MRI) imaging. The 2017 version also introduces contrast-enhanced ultrasound as a novel approach to diagnosis. Indeed, imaging techniques have evolved to improve diagnostic accuracy and characterization of HCC lesions. Newer techniques, such as T1 mapping, intravoxel incoherent motion analysis and textural analysis, assess specific characteristics that may help grade the tumor and guide management, allowing for a more personalized approach to patient care. This review aims to analyze the utility of imaging in the surveillance and diagnosis of HCC and to assess novel techniques which may increase the accuracy of imaging and determine optimal treatment strategies.
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20
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Kim MJ, Lee S, An C. Problematic lesions in cirrhotic liver mimicking hepatocellular carcinoma. Eur Radiol 2019; 29:5101-5110. [PMID: 30788586 DOI: 10.1007/s00330-019-06030-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
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21
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Kim TH, Kim SY, Tang A, Lee JM. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma: 2018 update. Clin Mol Hepatol 2019; 25:245-263. [PMID: 30759967 PMCID: PMC6759428 DOI: 10.3350/cmh.2018.0090] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
The goal of this review is to present the similarities and differences among the latest guidelines for noninvasive diagnosis of hepatocellular carcinoma (HCC) of American Association for the Study of Liver Disease (AASLD), European Association for the Study of the Liver (EASL), Liver Imaging Reporting and Data System (LI-RADS), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) of Korea. In 2018, major guideline updates have been proposed by the AASLD, EASL and KLCA-NCC; AASLD newly incorporated LI-RADS into their HCC diagnostic algorithm. The AASLD and EASL guidelines now include magnetic resonance imaging (MRI) using hepatobiliary contrast media as a first-line diagnostic test in addition to dynamic computed tomography and MRI using extracellular contrast media and the KLCA-NCC and EASL guidelines also include contrast-enhanced ultrasound as a second-line diagnostic test. We will comprehensively review the HCC surveillance and diagnostic algorithms and compare and highlight key features for each guideline. We also address limitations of current systems for the noninvasive diagnosis of HCC.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - An Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Québec, Canada
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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22
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MR features based on LI-RADS identify cytokeratin 19 status of hepatocellular carcinomas. Eur J Radiol 2019; 113:7-14. [PMID: 30927962 DOI: 10.1016/j.ejrad.2019.01.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/18/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To retrospectively evaluate the value of MR features based on Liver Imaging Reporting and Data System (LI-RADS ver.2017) for identifying the status of cytokeratin (CK) 19 expression of HCC before surgery. METHODS A total of 201 patients with 207 HCCs who underwent MR imaging were reviewed retrospectively. MR features based on LI-RADS ver.2017 as well as clinical data were compared between CK19-positive (n = 51) and CK19-negative (n = 156) HCCs groups. Potential predictive parameters were identified by univariate and multivariate logistic regression analysis and diagnostic odds ratios (ORs) were recorded. RESULTS MR features including targetoid appearance (p = 0.001) was more frequently observed while non-peripheral "washout" (p < 0.0001) and non-rim arterial phase hyper-enhancement (p < 0.0001) were found less frequently in CK19-positive HCCs compared to CK19-negative HCCs. At multivariate analysis, serum alphafetoprotein (AFP)>20 ng/ml (OR = 5.9) and targetoid appearance (OR = 4.2) and non-peripheral "washout" (OR = 0.2) were significant independent predictors of CK19-positive HCCs. CONCLUSION Targetoid appearance and absence non-peripheral "washout" combined with elevated AFP were useful for differentiating CK19-positive HCCs from CK19-negative HCC.
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23
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Chernyak V, Fowler KJ, Kamaya A, Kielar AZ, Elsayes KM, Bashir MR, Kono Y, Do RK, Mitchell DG, Singal AG, Tang A, Sirlin CB. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology 2018; 289:816-830. [PMID: 30251931 DOI: 10.1148/radiol.2018181494] [Citation(s) in RCA: 763] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is composed of four individual algorithms intended to standardize the lexicon, as well as reporting and care, in patients with or at risk for hepatocellular carcinoma in the context of surveillance with US; diagnosis with CT, MRI, or contrast material-enhanced US; and assessment of treatment response with CT or MRI. This report provides a broad overview of LI-RADS, including its historic development, relationship to other imaging guidelines, composition, aims, and future directions. In addition, readers will understand the motivation for and key components of the 2018 update.
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Affiliation(s)
- Victoria Chernyak
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Kathryn J Fowler
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Aya Kamaya
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Ania Z Kielar
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Khaled M Elsayes
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Mustafa R Bashir
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Yuko Kono
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Richard K Do
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Donald G Mitchell
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Amit G Singal
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - An Tang
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
| | - Claude B Sirlin
- From the Department of Radiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (V.C.); Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Duke University Medical Center, Durham, NC (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Medicine and Radiology (Y.K.), and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego, San Diego, Calif; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.D.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (D.G.M.); Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas Tex (A.G.S.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (A.T.)
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CT/MRI LI-RADS v2017 - review of the guidelines. Pol J Radiol 2018; 83:e355-e365. [PMID: 30627260 PMCID: PMC6323546 DOI: 10.5114/pjr.2018.78391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 01/27/2023] Open
Abstract
The Liver Imaging-Reporting and Data System (LI-RADS or LR) is a classification system for reading and reporting imaging studies in patients with high risk for hepatocellular carcinoma (HCC). One of its main goals is to improve communication between specialties, especially radiologists, hepatologists, surgeons, and pathologists. LI-RADS defines imaging features of the lesions and stratifies the risk of HCC into categories. It is the most comprehensive and highly specific system; however, its seeming complexity prevents many radiologists from using it in everyday practice. This article is a detailed review of the latest version of LI-RADS (v. 2017), which should be helpful for radiologists who are not very familiar with the system and its latest update.
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Lee JY, Huo EJ, Weinstein S, Santos C, Monto A, Corvera CU, Yee J, Hope TA. Evaluation of an abbreviated screening MRI protocol for patients at risk for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1627-1633. [PMID: 29018942 DOI: 10.1007/s00261-017-1339-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE In this study, we compare an abbreviated screening MRI protocol (aMRI), utilizing only dynamic contrast-enhanced images, to a conventional liver MRI (cMRI) for the characterization of observations in at-risk patients. MATERIALS AND METHODS 164 consecutive HCC screening MRIs were retrospectively analyzed. Two sets of de-identified image sets were created: one with all acquired sequences including T2- and diffusion-weighted sequences (cMRI), and one with only T1-weighted precontrast and dynamic post-contrast images utilizing an extracellular gadolinium contrast agent (aMRI). Three readers assigned a LI-RADS score based on the lesion with the highest LI-RADS category using the aMRI and cMRI datasets during separate reads. RESULTS There was no change between the aMRI and cMRI LI-RADS categorization in 93%, 96%, and 96% of cases for readers 1, 2, and 3, respectively. In the majority of the discrepant cases, the score increased from LI-RADS 3 to LI-RADS 4 due to the presence of ancillary features on T2 and DWI. Kappa values for interobserver variability demonstrated fair-to-moderate LI-RADS agreement among the 3 readers. CONCLUSION There was strong agreement between the abbreviated T1-only MRI protocol and a full liver MRI, with only 5% of cases changing LI-RADS categorization due to the inclusion of T2 and DWI. The estimated time to run this abbreviated MRI is approximately 7-10 min, possibly allowing for a more cost-effective screening MRI than our cMRIs.
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Affiliation(s)
- Jennifer Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Eugene J Huo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Stefanie Weinstein
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Charmaine Santos
- Department of Radiology, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander Monto
- Department of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carlos U Corvera
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Judy Yee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
- Department of Radiology, Veterans Affairs Medical Center, San Francisco, CA, USA.
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Patella F, Pesapane F, Fumarola EM, Emili I, Spairani R, Angileri SA, Tresoldi S, Franceschelli G, Carrafiello G. CT-MRI LI-RADS v2017: A Comprehensive Guide for Beginners. J Clin Transl Hepatol 2018; 6:222-236. [PMID: 29951368 PMCID: PMC6018316 DOI: 10.14218/jcth.2017.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide. Early diagnosis is essential for correct management and improvement of prognosis. Proposed for the first time in 2011 and updated for the last time in 2017, the Liver Imaging-Reporting and Data System (LI-RADS) is a comprehensive system for standardized interpretation and reporting of computed tomography (CT) and magnetic resonance imaging (MRI) liver examinations, endorsed by the American College of Radiology to achieve congruence with HCC diagnostic criteria in at-risk populations. Understanding its algorithm is fundamental to correctly apply LI-RADS in clinical practice. In this pictorial review, we provide a guide for beginners, explaining LI-RADS indications, describing major and ancillary features and eventually elucidating the diagnostic algorithm with the use of some clinical examples.
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Affiliation(s)
- Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
- *Correspondence to: Filippo Pesapane, Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy. Tel: +39-13012751123; Fax: +39-2-50323393; E-mail:
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Riccardo Spairani
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Silvia Tresoldi
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Giuseppe Franceschelli
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
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Jeon SK, Joo I, Lee DH, Lee SM, Kang HJ, Lee KB, Lee JM. Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging. Eur Radiol 2018; 29:373-382. [PMID: 29955948 DOI: 10.1007/s00330-018-5605-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the performance of the Liver Imaging Reporting and Data System (LI-RADS) v2017 for combined hepatocellular cholangiocarcinoma (cHCC-CCA) in the differential diagnosis from hepatocellular carcinoma (HCC) and prediction of prognosis on gadoxetic acid-enhanced MRI (Gd-EOB-MRI). METHODS Patients at high risk of HCC with pathologically confirmed cHCC-CCAs (n = 70) and a matched control of HCCs (n = 70) who had undergone Gd-EOB-MRI were included. LI-RADS category was assigned for each lesion by two radiologists. Imaging features and surgical outcomes were compared between cHCC-CCAs of LR-M and LR-5/4 using the χ2 test or Fisher's exact test. Recurrence-free survival (RFS) was estimated using Kaplan-Meier survival curves and compared using the log-rank test. RESULTS cHCC-CCAs and HCCs were categorised as LR-M, LR-5/4 and LR-TIV in 61.4% (43/70), 37.1% (26/70) and 1.4% (1/70) and 10.0% (7/70), 88.6% (62/70) and 1.4% (1/70), respectively. cHCC-CCAs of LR-5/4, in comparison to LR-M, showed significantly higher frequencies of major HCC features: arterial hyperenhancement (96.2% (25/26) vs. 58.1% (25/43), p = 0.001), washout appearance (80.8% (21/26) vs. 48.8% (21/43), p = 0.011) and enhancing capsule (34.6% (9/26) vs. 11.6% (5/43), p = 0.031). After curative surgery, patients with cHCC-CCAs of LR-M showed a higher early recurrence rate (≤ 6 months) than did those with LR-5/4 (27.8% (10/36) vs. 4.8% (1/21), p = 0.041), whereas no significant difference was observed in RFS (log-rank p = 0.084). CONCLUSIONS By using LI-RADS on Gd-EOB-MRI, a substantial proportion of cHCC-CCAs can be categorised as non-LR-M. In addition, cHCC-CCAs mimicking HCCs on imaging (LR-5/4) may indicate better surgical outcomes with regard to early recurrence than those of LR-M. KEY POINTS • cHCC-CCAs can be categorised as either LR-M or non-LR-M on Gd-EOB-MRI. • cHCC-CCAs of LR-5/4 frequently demonstrate major HCC imaging features. • LI-RADS categorisation may provide prognostic information after surgery in cHCC-CCAs.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kyoung-Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Elsayes KM, Hooker JC, Agrons MM, Kielar AZ, Tang A, Fowler KJ, Chernyak V, Bashir MR, Kono Y, Do RK, Mitchell DG, Kamaya A, Hecht EM, Sirlin CB. 2017 Version of LI-RADS for CT and MR Imaging: An Update. Radiographics 2018; 37:1994-2017. [PMID: 29131761 DOI: 10.1148/rg.2017170098] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a reporting system created for the standardized interpretation of liver imaging findings in patients who are at risk for hepatocellular carcinoma (HCC). This system was developed with the cooperative and ongoing efforts of an American College of Radiology-supported committee of diagnostic radiologists with expertise in liver imaging and valuable input from hepatobiliary surgeons, hepatologists, hepatopathologists, and interventional radiologists. In this article, the 2017 version of LI-RADS for computed tomography and magnetic resonance imaging is reviewed. Specific topics include the appropriate population for application of LI-RADS; technical recommendations for image optimization, including definitions of dynamic enhancement phases; diagnostic and treatment response categories; definitions of major and ancillary imaging features; criteria for distinguishing definite HCC from a malignancy that might be non-HCC; management options following LI-RADS categorization; and reporting. ©RSNA, 2017.
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Affiliation(s)
- Khaled M Elsayes
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Jonathan C Hooker
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Michelle M Agrons
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Ania Z Kielar
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - An Tang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Kathryn J Fowler
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Victoria Chernyak
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Mustafa R Bashir
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Yuko Kono
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Richard K Do
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Donald G Mitchell
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Aya Kamaya
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Elizabeth M Hecht
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Claude B Sirlin
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
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Cerny M, Bergeron C, Billiard JS, Murphy-Lavallée J, Olivié D, Bérubé J, Fan B, Castel H, Turcotte S, Perreault P, Chagnon M, Tang A. LI-RADS for MR Imaging Diagnosis of Hepatocellular Carcinoma: Performance of Major and Ancillary Features. Radiology 2018; 288:118-128. [PMID: 29634435 DOI: 10.1148/radiol.2018171678] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To evaluate the performance of major features, ancillary features, and categories of Liver Imaging Reporting and Data System (LI-RADS) version 2014 at magnetic resonance (MR) imaging for the diagnosis of hepatocellular carcinoma (HCC). Materials and Methods This retrospective institutional review board-approved study included patients with liver MR imaging and at least one pathologically proved lesion. Between 2004 and 2016, 102 patients (275 observations including 113 HCCs) met inclusion criteria. Two radiologists independently assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS category. Per-lesion estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed by using generalized estimating equation models. Results Major features (arterial phase hyperenhancement, washout, capsule, and threshold growth) had a sensitivity of 88.5%, 60.6%, 32.9%, and 41.6%, and a specificity of 18.6%, 84.8%, 98.8%, and 83.2% for HCC, respectively. Ancillary features (mild-moderate T2 hyperintensity, restricted diffusion, mosaic architecture, intralesional fat, lesional fat sparing, blood products, and subthreshold growth) had a sensitivity of 62.2%, 54.8%, 9.9%, 30.9%, 23.1%, 2.8%, and 48.3%, and a specificity of 79.4%, 90.6%, 99.4%, 94.2%, 83.1%, 99.3%, and 91.4% for HCC, respectively. The LR-5 or LR-5 V categories had a per-lesion sensitivity of 50.8% and a specificity of 95.8% for HCC, respectively. The LR-4, LR-5, or LR-5 V categories (determined by using major features only vs combination of major and ancillary features) had a per-lesion sensitivity of 75.9% and 87.9% and a per-lesion specificity of 87.5% and 86.2%, respectively. Conclusion The use of ancillary features in combination with major features increases the sensitivity while preserving a high specificity for the diagnosis of HCC.
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Affiliation(s)
- Milena Cerny
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Catherine Bergeron
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Jean-Sébastien Billiard
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Jessica Murphy-Lavallée
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Damien Olivié
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Joshua Bérubé
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Boyan Fan
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Hélène Castel
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Simon Turcotte
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Pierre Perreault
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - Miguel Chagnon
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
| | - An Tang
- From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon)
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Comparison of Visualization Rates of LI-RADS Version 2014 Major Features With IV Gadobenate Dimeglumine or Gadoxetate Disodium in Patients at Risk for Hepatocellular Carcinoma. AJR Am J Roentgenol 2018; 210:1266-1272. [PMID: 29629800 DOI: 10.2214/ajr.17.18981] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study is to compare visualization rates of the major features covered by Liver Imaging Reporting and Data System (LI-RADS) version 2014 in patients at risk for hepatocellular carcinoma using either gadobenate dimeglumine or gadoxetate disodium IV contrast agent. MATERIALS AND METHODS This retrospective study included liver MRI examinations performed with either gadobenate dimeglumine or gadoxetate disodium contrast enhancement. Using age, sex, underlying liver disease, and presence of cirrhosis, patients were placed into matched cohorts. All hepatic nodules 1 cm or larger (up to five per subject) were included, resulting in 63 subjects with 130 nodules (median nodule size, 1.9 cm) imaged with gadobenate and 64 subjects with 117 nodules (median nodule size, 2.0 cm) imaged with gadoxetate. Three radiologists reviewed the studies for LI-RADS major features independently. Bootstrap resampling with 10,000 repetitions was used to compare feature detection rates. RESULTS Arterial phase hyperenhancement was seen in a similar number of nodules with gadobenate dimeglumine (mean, 91.5% [119/130]) and gadoxetate disodium (mean, 88.0% [103/117]) (p = 0.173). Dynamic phase washout was more commonly seen with gadobenate dimeglumine (mean, 60.2% [78.3/130]) than with gadoxetate disodium (mean, 45.3% [53/117]) (p = 0.006). The capsule feature was more often visualized with gadobenate dimeglumine (mean, 50.2% [65.3/130]) than with gadoxetate disodium (mean, 33.3% [39/117]) (p < 0.001). Interreader agreement for arterial phase enhancement and dynamic phase washout was almost perfect for both contrast agents (κ > 0.83). Agreement for the capsule feature was moderate for gadobenate dimeglumine (κ = 0.52) and substantial for gadoxetate disodium (κ = 0.67). CONCLUSION The rates of visualization of arterial phase hyperenhancement are similar in studies performed with gadobenate dimeglumine and gadoxetate disodium, but dynamic phase washout and capsule appearance are more commonly visualized with gadobenate dimeglumine.
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Chang W, Lee JM, Lee DH, Yoon JH, Kim YJ, Yoon JH, Han JK. Comparison of switching bipolar ablation with multiple cooled wet electrodes and switching monopolar ablation with separable clustered electrode in treatment of small hepatocellular carcinoma: A randomized controlled trial. PLoS One 2018; 13:e0192173. [PMID: 29420589 PMCID: PMC5805261 DOI: 10.1371/journal.pone.0192173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE A randomized controlled trial was conducted to prospectively compare the therapeutic effectiveness of switching bipolar (SB) radiofrequency ablation (RFA) using cooled-wet electrodes and switching monopolar (SM) RFA using separable clustered (SC) electrodes in patients with hepatocellular carcinomas (HCCs). MATERIALS AND METHODS This prospective study was approved by our Institutional Review Board. Between April 2014 and January 2015, sixty-nine patients with 74 HCCs were randomly treated with RFA using either internally cooled-wet (ICW) electrodes in SB mode (SB-RFA, n = 36) or SC electrodes in SM mode (SM-RFA, n = 38). Technical parameters including the number of ablations, ablation time, volume, energy delivery, and complications were evaluated. Thereafter, 1-year and 2-year local tumor progression (LTP) free survival rates were compared between the two groups using the Kaplan-Meier method. RESULTS In the SB-RFA group, less number of ablations were required (1.72±0.70 vs. 2.31±1.37, P = 0.039), the ablation time was shorter (10.9±3.9 vs.14.3±5.0 min, p = 0.004), and energy delivery was smaller (13.1±6.3 vs.23.4±12.8 kcal, p<0.001) compared to SM-RFA. Ablation volume was not significantly different between SB-RFA and SM-RFA groups (61.8±24.3 vs.54.9±23.7 cm3, p = 0.229). Technical failure occurred in one patient in the SM-RFA group, and major complications occurred in one patient in each group. The 1-year and 2-year LTP free survival rates were 93.9% and 84.3% in the SB-RFA group and 94.4% and 88.4% in the SM-RFA group (p = 0.687). CONCLUSION Both SB-RFA using ICW electrodes and SM-RFA using SC electrodes provided comparable LTP free survival rates although SB-RFA required less ablations and shorter ablation time.
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Affiliation(s)
- Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
- * E-mail:
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Yoon Jun Kim
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Jung Hwan Yoon
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
- Seoul National University College of Medicine, Jongno-gu, Seou, Korea
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32
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Tang A, Bashir MR, Corwin MT, Cruite I, Dietrich CF, Do RKG, Ehman EC, Fowler KJ, Hussain HK, Jha RC, Karam AR, Mamidipalli A, Marks RM, Mitchell DG, Morgan TA, Ohliger MA, Shah A, Vu KN, Sirlin CB, For the LI-RADS Evidence Working Group. Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review. Radiology 2018; 286:29-48. [PMID: 29166245 PMCID: PMC6677284 DOI: 10.1148/radiol.2017170554] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- An Tang
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Mustafa R. Bashir
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Michael T. Corwin
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Irene Cruite
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Christoph F. Dietrich
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Richard K. G. Do
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Eric C. Ehman
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Kathryn J. Fowler
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Hero K. Hussain
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Reena C. Jha
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | | | - Adrija Mamidipalli
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Robert M. Marks
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Donald G. Mitchell
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Tara A. Morgan
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Michael A. Ohliger
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Amol Shah
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Kim-Nhien Vu
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - For the LI-RADS Evidence Working Group
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
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Tang A, Cruite I, Mitchell DG, Sirlin CB. Hepatocellular carcinoma imaging systems: why they exist, how they have evolved, and how they differ. Abdom Radiol (NY) 2018; 43:3-12. [PMID: 28840293 DOI: 10.1007/s00261-017-1292-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past 16 years, several scientific organizations have proposed systems that incorporate imaging for surveillance, diagnosis, staging, treatment, and monitoring of treatment response of hepatocellular carcinoma (HCC). These systems are needed to standardize the acquisition, interpretation, and reporting of liver imaging examinations; help differentiate benign from malignant observations; improve consistency between radiologists; and provide guidance for management of HCC. This review article discusses the historical evolution of HCC imaging systems. We indicate the features differentiating these systems, including target population, screening and surveillance algorithm, diagnostic imaging modalities, diagnostic scope, expertise and technical requirements, terminology, major and ancillary imaging features, staging and transplant eligibility, and assessment of treatment response. We highlight the potential benefits of unifying the systems, which we anticipate will enable sharing, pooling, and meta-analysis of data; facilitate multi-center trials; and accelerate dissemination of knowledge.
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Affiliation(s)
- An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, Saint-Luc Hospital, University of Montreal and CRCHUM, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada.
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
| | - Irene Cruite
- Inland Imaging, Spokane, 801South Stevens St, Spokane, WA, 99204, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, 132 S. 10th St, 1094 Main Bldg., Philadelphia, PA, 19107, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
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Abstract
The Liver Imaging Reporting and Data System (LI-RADS) was created to provide a standardized way to both assess and communicate the likelihood of benignity or malignancy of observations seen in patients at risk for development of hepatocellular carcinoma (HCC). The LI-RADS categories allow radiologists to convey the full spectrum of concern for malignancy, from definitely benign to definitely HCC. Additional categories are available for non-categorizable observations, observations that are concerning for a non-HCC malignancy, and the presence of tumor in vein. The goal of this paper is to discuss the LI-RADS categories, including criteria for each category, and point out changes to the categories from prior versions of LI-RADS.
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Abstract
Since its introduction in 2011, Liver Imaging Reporting and Data System (LI-RADS) has become an increasingly utilized method for radiologists to categorize lesions for hepatocellular carcinoma (HCC) in patients at risk (American College of Radiology, www.acr.org/quality-safety/resources/lirads 2016). This overview article presents insight into methods of incorporating LI-RADS into an existing clinical practice, highlighting concrete ways to establish this system as a mainstay in any radiologist's evidence-based armamentarium. We will focus on the importance of standardization to improve the value of our reporting. We will also discuss specific opportunities to favor adoption of LI-RADS including building a community of users composed of radiologists and referring physicians, forming a strategic vision, enlisting a team leader, overcoming barriers to adoption, communicating successes, integrating the system into the departmental culture, and learning from mistakes. The 2017 version of LI-RADS is the most recent update and is based on the most current medical imaging evidence. The details of these updates are described in other articles in this journal's edition. Efforts should be made to increase adherence and to enhance standardized use of LI-RADS internationally. Ultimately, the objective of LI-RADS is to prioritize patient care and optimize medical outcomes.
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Interval Magnetic Resonance Imaging: an Alternative to Guidelines for Indeterminate Nodules Discovered in the Cirrhotic Liver. J Gastrointest Surg 2017; 21:1463-1470. [PMID: 28550393 DOI: 10.1007/s11605-017-3454-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/11/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current guidelines for the management of indeterminate nodules discovered on surveillance imaging recommend alternate imaging modality or biopsy. This study evaluates the use of short interval MRI rather than immediate CT or biopsy. METHOD This retrospective cohort study examines outcomes of 111 patients with indeterminate nodules reviewed by a single institution's Liver Tumor Board 2011-2016. Analysis was focused on outcomes stratified by management decision. RESULTS The tumor board recommended biopsy or immediate repeat CT imaging in 13 (12%), 3-month interval MRI in 64 (58%) and 6-month interval MRI for 34 (30%) patients. Twenty-eight (29%) patients in the interval MRI subgroups were diagnosed with hepatocellular carcinoma (HCC) during the period of follow-up, and 21 (75%) of these were located within the original indeterminate nodule. The median time to diagnosis was 6.5 months. Twenty-three (82%) were eligible for potentially curative therapy at the time of HCC diagnosis. Delay in HCC diagnosis was not the reason for inability to provide potentially curative therapy in any patient. CONCLUSION This study supports the judicious use of interval MRI at 3 or 6 months in patients with liver cirrhosis and an indeterminate liver nodule rather than immediate CT scan or biopsy.
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Fraum TJ, Tsai R, Rohe E, Ludwig DR, Salter A, Nalbantoglu ILK, Heiken JP, Fowler KJ. Differentiation of Hepatocellular Carcinoma from Other Hepatic Malignancies in Patients at Risk: Diagnostic Performance of the Liver Imaging Reporting and Data System Version 2014. Radiology 2017; 286:158-172. [PMID: 28853673 DOI: 10.1148/radiol.2017170114] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To evaluate the diagnostic performance and interrater reliability of the Liver Imaging Reporting and Data System (LI-RADS) version 2014 in differentiating hepatocellular carcinoma (HCC) from non-HCC malignancy in a population of patients at risk for HCC. Materials and Methods This retrospective HIPAA-compliant institutional review board-approved study was exempt from informed consent. A total of 178 pathology-proven malignant liver masses were identified in 178 patients at risk for HCC but without established extrahepatic malignancy from August 2012 through August 2015. Two readers blinded to pathology findings and clinical follow-up data independently evaluated a liver protocol magnetic resonance or computed tomography study for each lesion and assigned LI-RADS categories, scoring all major and most ancillary features. Statistical analyses included the independent samples t test, x2 test, Fisher exact test, and Cohen k. Results This study included 136 HCCs and 42 non-HCC malignancies. Specificity and positive predictive value of an HCC imaging diagnosis (LR-5 or LR-5V) were 69.0% and 90.5%, respectively, for reader 1 (R1) and 88.3% and 95.5%, respectively, for reader 2 (R2). Tumor in vein was a common finding in patients with non-HCC malignancies (R1, 10 of 42 [23.8%]; R2, five of 42 [11.9%]). Exclusion of the LR-5V pathway improved specificity and positive predictive value for HCC to 83.3% and 92.9%, respectively, for R1 (six fewer false-positive findings) and 92.3% and 96.4%, respectively, for R2 (one fewer false-positive finding). Among masses with arterial phase hyperenhancement, the rim pattern was more common among non-HCC malignancies than among HCCs for both readers (R1: 24 of 36 [66.7%] vs 13 of 124, [10.5%], P < .001; R2: 27 of 35 [77.1%] vs 21 of 123 [17.1%], P < .001) (k = 0.76). Exclusion of rim arterial phase hyperenhancement as a means of satisfying LR-5 criteria also improved specificity and positive predictive value for HCC (R1, two fewer false-positive findings). Conclusion Modification of the algorithmic role of tumor in vein and rim arterial phase hyperenhancement improves the diagnostic performance of LI-RADS version 2014 in differentiating HCC from non-HCC malignancy. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Tyler J Fraum
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Richard Tsai
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Eric Rohe
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R Ludwig
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Amber Salter
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - ILKe Nalbantoglu
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jay P Heiken
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Kathryn J Fowler
- From the Mallinckrodt Institute of Radiology (T.J.F., R.T., E.R., D.R.L., J.P.H., K.J.F.), Division of Biostatistics (A.S.), and Department of Pathology and Immunology (I.N.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Multiple arterial phase MRI of arterial hypervascular hepatic lesions: improved arterial phase capture and lesion enhancement. Abdom Radiol (NY) 2017; 42:870-876. [PMID: 27770162 DOI: 10.1007/s00261-016-0948-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To establish if triple-phase arterial imaging improves the detection of arterial phase hyperintense lesions based on arterial phase capture, motion artifact degradation, and lesion enhancement when compared to single-phase imaging. MATERIALS AND METHODS Patients at risk for hepatocellular carcinoma were imaged at 3.0T. Seventy-three consecutive patients with a standard single-phase MRI and eighty-five consecutive patients were imaged using extracellular contrast with triple arterial phase MRI using three sequential accelerated acquisitions of 8 s. Arterial phase capture and image quality were qualitatively categorized. Forty single-phase and forty-four triple-phase studies contained arterially enhancing lesions > 1 cm with washout appearance. The contrast-to-noise ratio (CNR) of the lesions was calculated. We compared the differences in means with Student t-tests and those in arterial phase capture with a Chi squared test with Yates correction. RESULTS The triple-phase acquisitions captured the early or late arterial phases more frequently than did the single-phase acquisition (99% vs 86%; P value = 0.006). Triple-phase also provided greater number of patients with early or late arterial phase imaging without motion artifact (92% vs 79%, P-value = 0.05). The lesion analysis revealed increased maximum CNR in the triple-phase imaging (704.4) vs. single-phase imaging (517.2), P-value < 0.001. CONCLUSION Triple-phase acquisition provides more robust arterial phase imaging for hepatic lesions, with increased lesion CNR, compared to standard single-phase arterial phase imaging.
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Sofue K, Burke LM, Nilmini V, Alagiyawanna M, Muir AJ, Choudhury KR, Jaffe TA, Semelka RC, Bashir MR. Liver imaging reporting and data system category 4 observations in MRI: Risk factors predicting upgrade to category 5. J Magn Reson Imaging 2017; 46:783-792. [DOI: 10.1002/jmri.25627] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/22/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Keitaro Sofue
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Lauren M.B. Burke
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Viragi Nilmini
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Madavi Alagiyawanna
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Andrew J. Muir
- Department of Medicine; Duke University Medical Center; Durham North Carolina USA
| | | | - Tracy A. Jaffe
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
| | - Richard C. Semelka
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Mustafa R. Bashir
- Department of Radiology; Duke University Medical Center; Durham North Carolina USA
- Center for Advanced Magnetic Resonance Development; Duke University Medical Center; Durham North Carolina USA
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Cruite I, Tang A, Mamidipalli A, Shah A, Santillan C, Sirlin CB. Liver Imaging Reporting and Data System: Review of Major Imaging Features. Semin Roentgenol 2016; 51:292-300. [DOI: 10.1053/j.ro.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Burke LMB, Sofue K, Alagiyawanna M, Nilmini V, Muir AJ, Choudhury KR, Semelka RC, Bashir MR. Natural history of liver imaging reporting and data system category 4 nodules in MRI. Abdom Radiol (NY) 2016; 41:1758-66. [PMID: 27145771 DOI: 10.1007/s00261-016-0762-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to characterize the MR imaging features and outcomes of liver imaging reporting and data system (LI-RADS) category 4 (LR4) nodules, with an emphasis on upgrade to category 5 (LR5) and development of contraindications to curative therapy. METHODS Institutional review board approval was obtained for this retrospective, dual-institutional Health Insurance Portability and Accountability Act-compliant study. The requirement for informed consent was waived. Contrast-enhanced MRI studies performed on patients with cirrhosis were retrospectively assessed using LI-RADS 2014 by at least two readers. All nodules were individually evaluated to determine their major imaging features at diagnosis, and follow-up data were used to determine the associated imaging outcomes. RESULTS One hundred eighty-one untreated LR4 nodules in 139 patients had adequate imaging and follow-up for inclusion in the study. Most (61% [111/181]) of these demonstrated arterial phase hyperenhancement, washout, and diameter less than 20 mm. During the follow-up period (median 163 days), 31% (56/181) of the nodules upgraded to LR5, 40% (73/181) remained stable, and 29% (52/181) downgraded. Of the nodules that upgraded, 61% (34/56) increased their size category and 54% (30/56) developed newly visualized capsules. No LR4 nodules developed venous invasion, satellites nodules, or new intrahepatic or extrahepatic metastatic disease. 75% (42/56) of the nodules that upgraded to LR5 did so within 6 months. CONCLUSIONS Approximately one-third of LR4 nodules upgrade to LR5, and the short-term risk of developing venous invasion or metastasis is very low.
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Affiliation(s)
- Lauren M B Burke
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keitaro Sofue
- Department of Radiology, Duke University Medical Center, 3808, Durham, NC, 27710, USA
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Madavi Alagiyawanna
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Viragi Nilmini
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew J Muir
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kingshuk R Choudhury
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, 3808, Durham, NC, 27710, USA.
- Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC, USA.
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Grözinger G, Bitzer M, Syha R, Ketelsen D, Nikolaou K, Lauer U, Horger M. Correlation of magnetic resonance signal characteristics and perfusion parameters assessed by volume perfusion computed tomography in hepatocellular carcinoma: Impact on lesion characterization. World J Radiol 2016; 8:683-692. [PMID: 27551338 PMCID: PMC4965352 DOI: 10.4329/wjr.v8.i7.683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To find out if magnetic resonance (MR)-signal characteristics of hepatocellular carcinomas (HCC) correlate with perfusion parameters assessed by volume perfusion computed tomography (VPCT).
METHODS: From October 2009 to January 2014, 26 (mean age, 69.3 years) patients with 36 HCC lesions who underwent both VPCT and MR liver imaging were analysed. We compared signal intensity in the T1w- and T2w-images and wash-in/wash-out kinetics on post-contrast MR images with mean values of blood flow (BF, mL/100 mL per minute), blood volume (BV, mL/100 mL), k-trans (mL/100 mL per minute), arterial liver perfusion (mL/100 mL per minute), portal venous perfusion and hepatic perfusion index (HPI, %) obtained by VPCT. Signal intensity on magnetic resonance imaging (MRI) was classified hyper/iso/hypointense compared with surrounding liver parenchyma.
RESULTS: Signal intensity on native T1w- and T2w-images was hyper/iso/hypo in 4/16/16 and 21/14/1 lesions, respectively. Wash-in and wash-out contrast kinetics were found on MRI in 33 of 36 lesions (91.7%) and 25 of 36 lesions (69.4%), respectively. The latter was observed significantly more often in higher graded lesions (P < 0.005). HPI was 94.7% ± 6.5%. There was no significant relationship between lesion’s MR-signal intensity, MR signal combinations, size and any of the VPCT-perfusion parameters. However HPI was constantly high in all HCC lesions.
CONCLUSION: VPCT parameters add limited value to MR-lesion characterization. However in HCC lesions with atypical MR signal characteristics HPI can add a parameter to ensure HCC diagnosis.
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Hicks RM, Yee J, Ohliger MA, Weinstein S, Kao J, Ikram NS, Hope TA. Comparison of diffusion-weighted imaging and T2-weighted single shot fast spin-echo: Implications for LI-RADS characterization of hepatocellular carcinoma. Magn Reson Imaging 2016; 34:915-21. [PMID: 27108359 DOI: 10.1016/j.mri.2016.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/17/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the performance of diffusion-weighted imaging (DWI) and T2-weighted single shot fast spin-echo (SSFSE) imaging of the liver in the detection of hepatocellular carcinoma (HCC) in reference to the LI-RADS classification system. METHODS MR images of 40 patients with 68 LI-RADS grade 3-5 lesions were analyzed. Two readers independently reviewed sequences and characterized lesion signal intensity, followed by consensus evaluation. CE-MRI served as reference standard. Sensitivities were compared across sequences. Lesion-to-liver contrast-to-noise ratios (CNRs) and apparent diffusion coefficients (ADCs) were measured and compared using the Wilcoxon signed-rank test across sequences and the Mann-Whitney U or Kruskal-Wallis test between LI-RADS categories. Inter-reader variability was assessed using Cohen's kappa statistic. RESULTS Consensus sensitivities of LI-RADS 3-5 lesions using SSFSE images versus DWI were similar (0.53-0.63, p=0.089), however, the sensitivity with DWI b=700 was higher (0.63) than DWI b=0 (0.53, p=0.039). Lesion-to-liver CNRs were larger for all DWI sequences compared to SSFSE images (p<0.001 for all). ADCs of large (>2cm) LIRADS 3-5 lesions were lower than those of small lesions (1.09±0.33 vs. 1.31±0.26, p=0.02), however lesion ADCs were not different from those of adjacent hepatic parenchyma for any LI-RADS lesion. CONCLUSIONS DWI has a similar sensitivity compared to SSFSE, but intensity on DWI likely represents intrinsic T2 signal hyper-intensity rather than restricted diffusion as the ADC values were not lower than adjacent parenchyma. Therefore it may not be appropriate to consider hyper-intensity on high b-value as a separate ancillary criteria to T2 hyper-intensity in LI-RADS.
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Affiliation(s)
- Robert M Hicks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Judy Yee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Stefanie Weinstein
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey Kao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Nabia S Ikram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA.
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Agnello F, Dioguardi Burgio M, Picone D, Vernuccio F, Cabibbo G, Giannitrapani L, Taibbi A, Agrusa A, Bartolotta TV, Galia M, Lagalla R, Midiri M, Brancatelli G. Magnetic resonance imaging of the cirrhotic liver in the era of gadoxetic acid. World J Gastroenterol 2016; 22:103-111. [PMID: 26755863 PMCID: PMC4698478 DOI: 10.3748/wjg.v22.i1.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/22/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Gadoxetic acid improves detection and characterization of focal liver lesions in cirrhotic patients and can estimate liver function in patients undergoing liver resection. The purpose of this article is to describe the optimal gadoxetic acid study protocol for the liver, the unique characteristics of gadoxetic acid, the differences between gadoxetic acid and extra-cellular gadolium chelates, and the differences in phases of enhancement between cirrhotic and normal liver using gadoxetic acid. We also discuss how to obtain and recognize an adequate hepatobiliary phase.
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45
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Sofue K, Sirlin CB, Allen BC, Nelson RC, Berg CL, Bashir MR. How reader perception of capsule affects interpretation of washout in hypervascular liver nodules in patients at risk for hepatocellular carcinoma. J Magn Reson Imaging 2015; 43:1337-45. [PMID: 26559157 DOI: 10.1002/jmri.25094] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/29/2015] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine whether reader perception of a capsule affects reader interpretation of washout in hypervascular liver nodules at dynamic magnetic resonance imaging (MRI) in patients at risk for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study was Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant, with waiver of informed consent. MRI reports for 111 hypervascular liver nodules (median 2.0 cm, range 1.0-17.8 cm) in 62 patients were reviewed, and the presence/absence of capsule and washout were recorded for one reading. A second independent study reading was also performed. The signal intensity ratio (SIR) for each nodule and liver parenchyma was measured. An objective SIR threshold was identified for nodules without capsules that correctly classified the presence/absence of washout, then applied to nodules with capsules to classify them as having / not having objective washout. Nodules were categorized as definite / not definite HCC using subjective and objective washout, based on LI-RADS, OPTN, AASLD, and EASL criteria, and proportions compared using McNemar's test. RESULTS Agreement on nodule features was high for Readings 1 and 2 (κ = 0.70-0.82). For Reading 1, 71 nodules lacked capsules (43 with and 28 without subjective washout); an SIR threshold of 0.88 classified the presence/absence of washout correctly in 94% (67/71, P < 0.001). Forty nodules had capsules; although all had subjective washout (100%, 40/40), 75% (30/40) had objective washout (P < 0.05). Using objective washout caused 4.5% (3/66; LI-RADS, OPTN) and 12% (10/83; AASLD, EASL) of nodules to be recategorized from definite HCC to not definite HCC. CONCLUSION Reader perception of capsule affects interpretation of washout. This effect can influence nodule categorization using imaging-based diagnostic systems. J. Magn. Reson. Imaging 2016;43:1337-1345.
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Affiliation(s)
- Keitaro Sofue
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Brian C Allen
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Rendon C Nelson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Carl L Berg
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
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Hope TA, Petkovska I, Saranathan M, Hargreaves BA, Vasanawala SS. Combined parenchymal and vascular imaging: High spatiotemporal resolution arterial evaluation of hepatocellular carcinoma. J Magn Reson Imaging 2015; 43:859-65. [PMID: 26340309 DOI: 10.1002/jmri.25042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/20/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To assess the ability of high-resolution arterial phase imaging of hepatocellular carcinoma (HCC) to provide combined vascular characterization and parenchymal evaluation. MATERIALS AND METHODS Thirty-eight consecutive studies in cirrhotic patients with HCC scanned with a view-shared 2-point-Dixon-based Differential Subsampling with Cartesian Ordering (DISCO) sequence were analyzed. Lesion contrast relative to precontrast and adjacent parenchyma was evaluated and compared using a Fisher's exact test. Visibility of hepatic arteries and tumor feeding vessels were graded on a 5-point scale. Catheter angiography was used as a reference standard for arterial anatomy. RESULTS The high spatiotemporal multiphasic acquisition allowed imaging of both the angiographic and late arterial phase in 30 of 38 studies with good image quality. Maximal lesion enhancement compared to precontrast occurred more frequently during the late arterial phase compared to maximal lesion-to-adjacent, which occurred more frequently during the early arterial phase (P < 0.001). Common and proper hepatic arteries were visualized adequately in 100%, right hepatic artery in 94-97%, left hepatic artery in 94%, and segmental vessel in 83% of cases. Arterial variants were detected with sensitivity of 87-100% and specificity of 100%. CONCLUSION High spatiotemporal resolution arterial phase imaging provides multiple angiographic and arterial phases in a single breath-hold, enabling accurate depiction of vascular anatomy while maintain optimal arterial phase imaging for characterization of focal lesions.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Iva Petkovska
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Manojkumar Saranathan
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA.,Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Shreyas S Vasanawala
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Update on the Liver Imaging Reporting and Data System: What the Pathologist Needs to Know. Adv Anat Pathol 2015; 22:314-22. [PMID: 26262514 DOI: 10.1097/pap.0000000000000089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is frequently diagnosed noninvasively with imaging techniques. Computed tomography and magnetic resonance imaging play critical roles in the detection, diagnosis, and staging of HCC. Standardization in the interpretation and reporting of imaging modalities has not existed until recently. In 2008, the American College of Radiology supported the development of the Liver Imaging Reporting and Data System (LI-RADS) for standardized terminology, interpretation, and reporting of imaging examinations for the diagnosis of HCC inpatients at risk for HCC. This article reviews the basic concepts of LI-RADS, emphasizing aspects that are most relevant to pathologists, including the categories, diagnostic algorithm, major features, and ancillary features for the diagnosis of HCC. The similarities and differences between LI-RADS and other major radiology-based diagnostic systems in terms of target population, intended users, categorization of observations, and imaging methods are addressed. Importantly, LI-RADS and other systems are designed to diagnose progressed HCC with high specificity and modest sensitivity. LI-RADS and other systems are not designed to detect early HCC and so have limited sensitivity for such lesions. Moreover, despite continuous advances in imaging technology, imaging detection and characterization of small (<1 cm) nodules remains limited; in addition, colocalization of small nodules and pathology is difficult. For these reasons LI-RADS and most other systems require lesions to be 1 cm or greater for the noninvasive diagnosis of HCC. As LI-RADS evolves, it is critical that stakeholders, including pathologists, provide expert input to help standardize and enhance reporting of radiologic findings.
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Arif-Tiwari H, Kalb B, Chundru S, Sharma P, Costello J, Guessner RW, Martin DR. MRI of hepatocellular carcinoma: an update of current practices. Diagn Interv Radiol 2015; 20:209-21. [PMID: 24808419 DOI: 10.5152/dir.2014.13370] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD.
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Affiliation(s)
- Hina Arif-Tiwari
- From the Departments of Medical Imaging University of Arizona College of Medicine, Tucson, Arizona, USA.
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Santillan CS, Tang A, Cruite I, Shah A, Sirlin CB. Understanding LI-RADS: a primer for practical use. Magn Reson Imaging Clin N Am 2015; 22:337-52. [PMID: 25086933 DOI: 10.1016/j.mric.2014.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The Liver Imaging-Reporting and Data System (LI-RADS) is a comprehensive system for standardized interpretation and reporting of computed tomography and magnetic resonance examinations performed in patients at risk for hepatocellular carcinoma. LI-RADS includes a diagnostic algorithm, lexicon, and atlas as well as suggestions for reporting, management, and imaging techniques. This primer provides an introduction to LI-RADS for radiologists including an explanation of the diagnostic algorithm, descriptions of the categories, and definitions of the major imaging features used to categorize observations with case examples.
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Affiliation(s)
- Cynthia S Santillan
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92130, USA
| | - An Tang
- Department of Radiology, Hôpital Saint-Luc, Centre de recherché du Centre hospitalier de l'Université de Montréal, Université de Montréal, 1058 Saint-Denis, Montréal, Québec H2X 3J4, Canada
| | - Irene Cruite
- Department of Radiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195-6113, USA
| | - Amol Shah
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92130, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92130, USA.
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Abstract
The currently accepted major diagnostic criteria for identifying hepatocellular carcinoma (HCC) on dynamic cross-sectional imaging consist of diffuse arterial phase hyperenhancement within the lesion, portal venous or delayed phase washout, and the presence and appearance of a capsule; also included in this criteria is interval threshold growth. Ancillary features such as intralesional fat, blood products, and mosaic architecture also favor a diagnosis of HCC. Tumor in a portal or hepatic vein is a definitive finding for an HCC even if a parenchymal mass is not clearly seen.
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Affiliation(s)
- Munazza Anis
- Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
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