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LI-RADS version 2018 for hepatocellular carcinoma < 1.0 cm on gadoxetate disodium–enhanced magnetic resonance imaging

  • Gastrointestinal
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Abstract

Objectives

We aimed to develop and evaluate a modified Liver Imaging Reporting and Data System (LI-RADS) version 2018 using significant ancillary features for diagnosing hepatocellular carcinoma (HCC) < 1.0 cm on gadoxetate disodium–enhanced magnetic resonance imaging (MRI).

Methods

Patients who underwent preoperative gadoxetate disodium–enhanced MRI for focal solid nodules < 2.0 cm within 1 month of MRI between January 2016 and December 2020 were retrospectively analyzed. Major and ancillary features were compared between HCCs of < 1.0 cm and 1.0–1.9 cm using the chi-square test. Significant ancillary features associated with HCC < 1.0 cm were determined by univariable and multivariable logistic regression analysis. The sensitivity and specificity of LR-5 were compared between LI-RADS v2018 and our modified LI-RADS (applying the significant ancillary feature) using generalized estimating equations.

Results

Of 796 included nodules, 248 were < 1.0 cm and 548 were 1.0–1.9 cm. HCC < 1.0 cm less frequently showed an enhancing capsule (7.1% vs. 31.1%, p < .001) and threshold growth (0% vs. 8.3%, p = .007) than HCC of 1.0−1.9 cm. Restricted diffusion was the only ancillary feature significant for diagnosing HCC < 1.0 cm (adjusted odds ratio = 11.50, p < .001). In the diagnosis of HCC, our modified LI-RADS using restricted diffusion had significantly higher sensitivity than LI-RADS v2018 (61.8% vs. 53.5%, p < .001), with similar specificity (97.3% vs. 97.8%, p = .157).

Conclusion

Restricted diffusion was the only significant independent ancillary feature for diagnosing HCC < 1.0 cm. Our modified LI-RADS using restricted diffusion can improve the sensitivity for HCC < 1.0 cm.

Key Points

• The imaging features of hepatocellular carcinoma (HCC) < 1.0 cm differed from those of HCC of 1.0–1.9 cm.

• Restricted diffusion was the only significant independent ancillary feature for HCC < 1.0 cm.

• Modified Liver Imaging Reporting and Data System (LI-RADS) with the addition of restricted diffusion can improve the sensitivity for HCC < 1.0 cm.

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Abbreviations

APHE:

Arterial-phase hyperenhancement

CCA:

Cholangiocarcinoma

CT:

Computed tomography

DWI:

Diffusion-weighted image

HBP:

Hepatobiliary-phase image

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

TP:

Transitional phase

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Funding

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

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Hyeon Ji Jang, Sang Hyun Choi, Se ** Choi, Jae Ho Byun, Hyung ** Won & Yong Moon Shin

  2. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Won-Mook Choi

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  1. Hyeon Ji Jang
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Correspondence to Sang Hyun Choi.

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The scientific guarantor of this publication is Sang Hyun Choi.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Jang, H.J., Choi, S.H., Choi, S.J. et al. LI-RADS version 2018 for hepatocellular carcinoma < 1.0 cm on gadoxetate disodium–enhanced magnetic resonance imaging. Eur Radiol 33, 5792–5800 (2023). https://doi.org/10.1007/s00330-023-09554-8

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