Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2019; 25(5): 622-631
Published online Feb 7, 2019. doi: 10.3748/wjg.v25.i5.622
Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?
Tong Zhang, Zi-Xing Huang, Yi Wei, Han-Yu Jiang, Jie Chen, Xi-Jiao Liu, Li-Kun Cao, Ting Duan, Xiao-Peng He, Chun-Chao Xia, Bin Song
Tong Zhang, Zi-Xing Huang, Yi Wei, Han-Yu Jiang, Jie Chen, Xi-Jiao Liu, Li-Kun Cao, Ting Duan, Xiao-Peng He, Chun-Chao Xia, Bin Song, Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang T, Wei Y, and Song B designed the research; Zhang T, Huang ZX, Jiang HY, and Chen J conducted literature search and analysis; Liu XJ, Cao Lk, Duan T, He XP, and Xia CC provided material support; Song B provided funding for the article; Zhang T and Huang ZX wrote the paper.
Supported by National Natural Science Foundation of China, No. 81471658; and Science and Technology Support Program of Sichuan Province, No. 2017SZ0003.
Institutional review board statement: This study was approved by the Ethics Committee of West China Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because this retrospective study used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bin Song, MD, Chief Doctor, Doctor, Professor, Department of Radiology, Sichuan University West China Hospital, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China. anicesong@vip.sina.com
Telephone: +86-28-85423680 Fax: +86-28-85582499
Received: October 19, 2018
Peer-review started: October 19, 2018
First decision: December 20, 2018
Revised: December 25, 2018
Accepted: January 14, 2019
Article in press: January 14, 2019
Published online: February 7, 2019
Processing time: 103 Days and 2.7 Hours
Abstract
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.

Keywords: Hepatocellular carcinoma; Liver Imaging Reporting and Data System; Magnetic resonance imaging; Diffusion-weighted imaging; Diagnosis

Core tip: The aim of this study was to determine whether the use of diffusion-weighted imaging (DWI) improves the diagnostic efficiency of the Liver Imaging Reporting and Data System (LI-RADS) v2017 with gadoxetic acid-enhanced magnetic resonance (MR) for hepatocellular carcinoma (HCC). A total of 245 observations in 203 patients were analyzed. 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. Using LI-RADS v2017 with gadoxetic acid-enhanced MR combined with DWI may result in a more accurate diagnosis of HCC.