To evaluate the usefulness of the radiomic model in predicting early (≤2 years) and late (>2 years) recurrence after curative resection in cases involving a single hepatocellular carcinoma (HCC) 2-5 ...cm in diameter using preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI), in comparison with the clinicopathologic model.
This retrospective study included 167 patients with surgically resected and pathologically confirmed single HCC 2-5 cm in diameter (
= 167, training set:validation set = 128:39) who underwent preoperative gadoxetic acid-enhanced MRI between January 2010 and December 2015. A radiomic model, a clinicopathologic model, and a combined clinicopathologic-radiomic (CCR) model were built using a random survival forest to predict disease-free survival (DFS) in the following conditions: early DFS versus late DFS, dynamic phases, and the peritumoral area included in the segmentation.
The radiomic model showed a prognostic performance comparable with the clinicopathologic model only with 3-mm peritumoral border extension c-index difference (radiomic-clinicopathologic), -0.021,
= 0.758. The CCR model with the 3-mm border extension showed the highest c-index value but no statistically significant improvement over the clinicopathologic model CCR, 0.716 (0.627-0.799); clinicopathologic model, 0.696 (0.557-0.799).
The prognostic value of the preoperative radiomic model with 3-mm border extension showed comparable performance with that of the postoperative clinicopathologic model for predicting DFS of early recurrence of HCC using gadoxetic acid-enhanced MRI. This suggests the importance of including peritumoral changes in the radiomic analysis of HCC.
Objectives
To evaluate the diagnostic performance of the LI-RADS (v2014) on gadoxetate-enhanced MRI prospectively applied in actual practice.
Methods
We retrospectively reviewed the prospectively ...written radiology reports of 143 treatment-naïve at-risk patients who underwent gadoxetate-enhanced liver MRI from January to December 2014, and identified 202 hepatic observations categorized using the LI-RADS. The diagnostic performances of LI-RADS categories for hepatocellular carcinoma (HCC) and hepatic malignancy were calculated.
Results
Twenty (69.0 %) of 29 LR-4, 73 (97.3 %) of 75 LR-5, and all of five (100 %) LR-5V observations were HCCs. The remaining two (2.7 %) LR-5 observations were combined hepatocellular-cholangiocarcinomas, while 10 (76.9 %) of 13 LR-M observations were HCCs. The sensitivity and specificity of LR-5/5V for HCC were 60.5 % and 97.3 %, respectively. Including LR-M in the diagnostic criteria for HCC increased sensitivity (68.2 %,
p
= 0.002) but decreased specificity without statistical significance (93.2 %,
p
= 0.154). LR-5/5V/M yielded sensitivity of 68.9 % and specificity of 100.0 % for hepatic malignancy.
Conclusions
LI-RADS v2014 was successfully applied on gadoxetate-enhanced MRI in clinical practice. LR-5/5V was the most specific diagnostic measure for HCC, but most LR-M observations were HCCs and a considerable portion of non-HCC malignancies were categorized as LR-4 or LR-5.
Key Points
•
LR-5/5V provided a highly specific diagnosis for HCC
.
•
Half of non-HCC malignancies were categorized as LR-4 or LR-5
.
•
The majority of LR-M observations were finally diagnosed as HCCs
.
•
More sensitive diagnosis of HCC was feasible with LR-5/5V/M on gadoxetate-enhanced MRI
.
•
Observations in either LR-5/5V or LR-M categories were definitely malignant
.
Objectives
To investigate the diagnostic accuracy of each LR-M feature defined in version 2017 of the Liver Imaging Reporting and Data System (LI-RADS) and determine the optimal LR-M feature for ...differentiating combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and hepatocellular carcinoma (HCC) on gadoxetate-enhanced magnetic resonance imaging (MRI).
Methods
Ninety-nine patients with pathologically proven cHCC-CCA (
n
= 33) or HCC (
n
= 66) after surgery were identified. Two radiologists retrospectively assessed preoperative gadoxetate-enhanced MRI for features favoring non-HCC malignancies (LR-M features) according to LI-RADS version 2017. Multivariate logistic regression analysis was performed to determine the independent differential features. The sensitivity and specificity for diagnosing cHCC-CCA were calculated for each LR-M feature.
Results
Targetoid appearance showed the highest sensitivity (75.8%, 95% confidence interval CI 60.6%, 87.3%) to correctly identify cHCC-CCA as LR-M. At least one LR-M feature was observed in 31 (93.9%) patients with cHCC-CCA and 34 (51.5%) patients with HCC. The sensitivity and specificity for diagnosing cHCC-CCA using the presence of any one of the LR-M features were 93.9% (95% CI 80.7, 98.9) and 48.5% (95% CI 41.9, 51.0), respectively. The presence of three LR-M features yielded the highest diagnostic accuracy of 80.8% (95% CI 72.1, 86.1) with a reduced sensitivity of 54.5% (95% CI 41.4, 62.5).
Conclusion
The majority of cHCC-CCA cases can be properly categorized as LR-M when any one of the LR-M features defined in the LI-RADS version 2017 is used as a determiner. However, approximately half of HCC cases also show at least one LR-M feature.
Key Points
• Targetoid appearance, including rim APHE, peripheral “washout” appearance, and delayed central enhancement, was the LR-M feature that identified cHCC-CCA as a non-HCC malignancy with the highest sensitivity.
• Most cHCC-CCA cases can be properly categorized as LR-M when the presence of any one of the LR-M features was used as the determiner.
• Approximately half of HCC cases also showed at least one LR-M feature.
Objectives
To evaluate how sarcomatoid carcinomas (SCs) would be classified on magnetic resonance imaging (MRI) by using the Liver Imaging Reporting and Data System (LI-RADS) and to assess imaging ...features of SC compared with other hepatic malignancies.
Methods
We retrieved 184 patients with pathologically confirmed SC (
n
= 46), hepatocellular carcinoma (HCC,
n
= 92), and intrahepatic cholangiocarcinoma (iCCA,
n
= 46) diagnosed between January 2006 and December 2017. Two readers independently reviewed MRI according to LI-RADS v2017. Classification rate of SC, as probably or definitely malignant but not specific for HCC (LR-M), was calculated. LR-TIV (tumor in vein) was subclassified as either 5V or MV. MRI features were compared between SC, HCC, and iCCA and between SC of LR-M and non-LR-M categories.
Results
Chronic liver disease was present in 71.7% (33/46) of patients with SC, and LI-RADS was applied for these patients. SC was classified as LR-M in 24 (72.7%) of 33 patients at risk. SCs that had been classified as LR-4/5/5V were significantly smaller (median, 1.9 cm; range, 1.0–4.2 cm) than SCs classified as LR-M/MV (median, 4.3 cm; range, 1.3–20.6 cm) on independent
t
test (
p
= 0.012). SCs commonly showed MRI features similar to iCCAs than to HCCs. Targetoid appearance and capsular retraction were more frequent in iCCA than in SC (
p
≤ 0.009) on Pearson’s chi-squared test or Fisher’s exact test.
Conclusion
Most SCs can be classified as LR-M on MRI, but small lesions may be indistinguishable from HCCs.
Key Points
• Most sarcomatoid carcinomas (SCs) are classified as LR-M on MRI by using LI-RADS v2017.
• SC showed various LR-M features similar to those of intrahepatic cholangiocarcinoma.
• Size of LR-4/5/5V SC was significantly smaller than that of LR-M/MV SC.
To identify magnetic resonance (MR) imaging features that enable prediction of early recurrence (<2 years) after curative resection of hepatocellular carcinoma (HCC) and to derive a preoperative ...prediction model.
This retrospective study was approved by the institutional review board. The requirement to obtain written informed consent was waived. A total of 268 patients who underwent hepatic resection for a single HCC from January 2008 to August 2011 were divided into two cohorts: a training cohort, which was used to derive a prediction model (n = 187), and a validation cohort (n = 81). All MR images from the training cohort were reviewed by two radiologists. A prediction model was constructed by using MR imaging features that were independently associated with early recurrence with use of multiple logistic regression analysis. The performance of the prediction model in the validation cohort was evaluated with respect to discrimination (ie, whether the relative ranking of individual predictions of subsequent early recurrence is in the correct order).
In the training cohort, four MR imaging features were independently associated with early recurrence: rim enhancement (odds ratio OR = 3.83; 95% confidence interval CI: 1.39, 10.52), peritumoral parenchymal enhancement in the arterial phase (OR = 2.64; 95% CI: 1.27, 5.46), satellite nodule (OR = 4.07; 95% CI: 1.09, 15.21), and tumor size (OR = 1.66; 95% CI: 1.31, 2.09). A prediction model derived from these variables showed an area under the receiver operating characteristic curve (AUC) of 0.788 in the prediction of the risk of early recurrence in the training cohort. When applied to the validation cohort, this model showed good discrimination (AUC, 0.783).
The prediction model derived from rim enhancement, peritumoral parenchymal enhancement, satellite nodule, and tumor size can be used preoperatively to estimate the risk of early recurrence after resection of a single HCC.
Objectives
To investigate the clinicopathologic significance of a subclassification of mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) into ductal and parenchymal types based on magnetic ...resonance imaging (MRI)
Methods
We enrolled 72 consecutive patients, in whom MF-iCCA was diagnosed on preoperative MRI and surgical resection from January 2000 to March 2013. Two readers independently evaluated MRI findings of adjacent bile duct dilation, periductal tumor spread, and presence of diffuse dilatation or abnormality of the intrahepatic bile duct. MF-iCCAs with none of the aforementioned findings were defined as parenchymal type, and those with one or more findings were defined as ductal type. The enhancement pattern in the arterial phase was also evaluated. Clinical and histopathological findings, as well as post-surgical outcomes, were collected from medical records.
Results
Parenchymal-type MF-iCCA (21/78, 27%) exhibited significantly lower serum carbohydrate antigen 19-9 (12.8 vs. 173.8 U/mL) and carcinoembryonic antigen (1.7 vs. 4.2 ng/mL), more frequent viral hepatitis (43% vs. 18%), less frequent biliary intraepithelial neoplasia (0% vs. 26%), and less frequent perineural invasion (0% vs. 59%) and lymph node metastasis (7% vs. 46%), compared with the ductal type (57/78, 73%) (
p
< 0.05 for all). Parenchymal-type MF-iCCA showed more frequent arterial hypervascularity (
p
= 0.001) and better overall survival (
p
= 0.030) than the ductal type.
Conclusion
Subclassification of MF-iCCAs into parenchymal and ductal types may be useful to discriminate clinical and histopathological characteristics and post-surgical outcomes.
Key Points
• We propose subclassification of mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) as parenchymal and ductal types, on the basis of magnetic resonance imaging findings of biliary abnormality.
• Two types of MF-iCCAs exhibit different clinical and histopathological characteristics and post-surgical outcomes.
Background & Aims
The liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing liver imaging in patients at high risk for hepatocellular carcinoma (HCC). We ...performed a meta‐analysis to determine the diagnostic performance of the LR‐5 category for HCC and the pooled proportions of HCCs in each LI‐RADS category using CT/MRI LI‐RADS v2017.
Methods
We searched multiple databases for original studies reporting on the diagnostic accuracy of CT/MRI LI‐RADS v2017. Random‐effects models were used to determine the summary estimates of the diagnostic performance of the LR‐5 category and the pooled proportions of HCCs for each LI‐RADS category. Risk of bias and concerns regarding applicability were evaluated with the Quality Assessment of Diagnostic Accuracy Studies‐2 tool.
Results
Fourteen studies (3 prospective studies and 11 retrospective studies) were included in the final analysis, consisting of 2056 patients, 2589 observations, and 1693 HCCs. The pooled per‐observation sensitivity was 67% (95% confidence interval CI, 62%‐72%) with specificity of 92% (95% CI, 88%‐95%) in the LR‐5 category of CT/MRI LI‐RADS v2017 for diagnosing HCC. The pooled proportions of HCCs were 0% (95% CI, 0%‐0%) for LR‐1, 4% (95% CI, 0%‐8%) for LR‐2, 34% (95% CI, 23%‐44%) for LR‐3, 67% (95% CI, 53%‐81%) for LR‐4, and 92% (95% CI, 87%‐96%) for LR‐5. The proportions of HCCs were significantly different among LI‐RADS categories 1‐5 (P = .034).
Conclusions
The LR‐5 category of CT/MRI LI‐RADS v2017 shows moderate sensitivity and high specificity for diagnosing HCC. Higher LI‐RADS categories contained higher proportions of HCCs.
Background
According to the Liver Imaging Reporting and Data System (LI‐RADS), the LI‐RADS category M (LR‐M), which are probably or definitely malignant but are not specific for hepatocellular ...carcinomas (HCCs), does not exclude HCCs. A gap in knowledge remains, including their characteristics and recurrence of HCCs categorized as LR‐M.
Purpose
To compare the characteristics of HCCs categorized as LR‐M with HCCs categorized as LR‐4 or LR‐5 (LR‐4/5) using the LI‐RADS version 2018 and evaluate the relationship of these categories with the risk of early recurrence after curative resections of single HCCs.
Study Type
Retrospective.
Subjects
Two hundred and eighty‐one patients (mean age, 57 years; 191 men and 90 women) who underwent curative resections for single HCCs and preoperative contrast‐enhanced MRI between 2015 and 2017.
Field Strength/Sequence
3T Dual gradient‐echo T1WI with in‐ and opposed‐phase, turbo spin‐echo T2WI, diffusion‐weighted echo‐planar images, and three‐dimensional gradient‐echo T1WI before and after administration of contrast agent.
Assessment
MRI features according to the LI‐RADS version 2018 were evaluated and LI‐RADS category were assigned for each observation. Clinical, imaging, and histopathological features were compared based on LI‐RADS categorization. Early recurrence rates (<2 years) and associated factors were also evaluated.
Statistical Tests
Fisher's exact test, two‐sample t test after satisfying assumption of normality through Shapiro–Wilk test, Fleiss κ coefficient, Cox proportional hazards regression analysis, Kaplan–Meier method, and log‐rank test.
Results
Forty‐one HCCs (14.6%) were categorized as LR‐M and 240 HCCs (85.4%) were categorized as LR‐4/5. LR‐M HCCs showed poorer differentiation than LR‐4/5 HCCs. In the multivariate analysis, the LR‐M category was an independent predictor for early recurrence (hazard ratio, 1.904; 95% confidence interval, 1.024–3.542; P < 0.05). Early recurrence rates were significantly higher in patients with LR‐M HCCs than in patients with LR‐4/5 HCCs (32.0% vs. 18.4%, respectively, P < 0 05).
Data Conclusion
Compared to LR‐4/5 HCCs, LR‐M HCCs were associated with poorer tumor differentiation and higher early recurrence rates after curative resections of single HCCs.
Level of Evidence: 3
Technical Efficacy Stage: 2
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