Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?
BACKGROUND
The Liver Imaging Reporting and Data System (LI-RADS), supported by the American College of Radiology (ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma (HCC). Diffusion-weighted imaging (DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging (MRI) for HCC.


AIM
To determine whether the use of DWI can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.


METHODS
In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity (SE), specificity (SP), accuracy (AC), positive predictive value (PPV), and negative predictive value (NPV) of LI-RADS were calculated. Youden index values were used to compare the diagnostic performance of LI-RADS with or without DWI.


RESULTS
Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS (kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and 71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and 75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR- 4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%, 75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.


CONCLUSION
LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.
['Zhang|Tong|T|', 'Huang|Zi-Xing|ZX|', 'Wei|Yi|Y|', 'Jiang|Han-Yu|HY|', 'Chen|Jie|J|', 'Liu|Xi-Jiao|XJ|', 'Cao|Li-Kun|LK|', 'Duan|Ting|T|', 'He|Xiao-Peng|XP|', 'Xia|Chun-Chao|CC|', 'Song|Bin|B|']
D000328:Adult D000368:Aged D001706:Biopsy D006528:Carcinoma, Hepatocellular D003287:Contrast Media D038524:Diffusion Magnetic Resonance Imaging D005260:Female D019786:Gadolinium DTPA D006498:Hepatectomy D006801:Humans D007090:Image Interpretation, Computer-Assisted D008099:Liver D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D015203:Reproducibility of Results D012189:Retrospective Studies D012680:Sensitivity and Specificity
Hepatocellular carcinoma Diffusion-weighted imaging Liver Imaging Reporting and Data System Magnetic resonance imaging Diagnosis