Song Y, Zhang YY, Yu Q, Ma R, Xiao Y, Shen JK, Wei CG. Modified LR-5 criteria based on gadoxetic acid can improve the sensitivity in the diagnosis of hepatocellular carcinoma. World J Radiol 2025; 17(3): 103822 [DOI: 10.4329/wjr.v17.i3.103822]
Corresponding Author of This Article
Yue Xiao, Department of Intensive Care Unit, Jieshou City People's Hospital (Jieshou Hospital Affiliated to Anhui Medical College), No. 399 East People's Road, Jieshou City, Fuyang 236500, Anhui Province, China. jsxiaoyue0313@163.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which 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/
Yan Song, Department of Radiology, Jieshou City People's Hospital (Jieshou Hospital Affiliated to Anhui Medical College), Fuyang 236500, Anhui Province, China
Yan Song, Yue-Yue Zhang, Qin Yu, Jun-Kang Shen, Chao-Gang Wei, Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou 215123, Jiangsu Province, China
Qin Yu, Department of Radiology, Dongtai City People's Hospital, Yancheng 224200, Jiangsu Province, China
Rui Ma, Department of Dialysis Center, Jieshou City People's Hospital (Jieshou Hospital Affiliated to Anhui Medical College), Fuyang 236500, Anhui Province, China
Yue Xiao, Department of Intensive Care Unit, Jieshou City People's Hospital (Jieshou Hospital Affiliated to Anhui Medical College), Fuyang 236500, Anhui Province, China
Co-first authors: Yan Song and Yue-Yue Zhang.
Co-corresponding authors: Yue Xiao and Chao-Gang Wei.
Author contributions: Song Y wrote the manuscript; Song Y and Zhang YY conceived and designed the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Shen JK and Xiao Y gave administrative support to the manuscript; Yu Q and Ma R to provide research materials or patients; Song Y and Yu Q collected and assembled the data; Wei CG and Yu Q contributed to the analysis and interpretation of the manuscript; Xiao Y and Wei CG contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Health Research Program of Anhui, No. AHWJ2024Ab0069.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Jieshou City People's Hospital, approval No. [2022] 21.
Informed consent statement: Written informed consent was not obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue Xiao, Department of Intensive Care Unit, Jieshou City People's Hospital (Jieshou Hospital Affiliated to Anhui Medical College), No. 399 East People's Road, Jieshou City, Fuyang 236500, Anhui Province, China. jsxiaoyue0313@163.com
Received: December 6, 2024 Revised: January 24, 2025 Accepted: February 21, 2025 Published online: March 28, 2025 Processing time: 114 Days and 21.2 Hours
Abstract
BACKGROUND
Currently, only tumors classified as LR-5 are considered definitive hepatocellular carcinoma (HCC), and no further pathologic confirmation is required to initiate therapy. Previous studies have shown that the sensitivity of LR-5 is modest, and lesions enhanced by gadoxetic acid (Gd-EOB-DTPA) may exhibit lower sensitivity than those enhanced by Gd-DTPA.
AIM
To identify malignant ancillary features (AFs) that can independently and significantly predict HCC in Liver Imaging Reporting and Data System version 2018, and to develop modified LR-5 criteria to improve diagnostic performance on Gd-EOB-DTPA - enhanced magnetic resonance imaging.
METHODS
Imaging data from patients with HCC risk factors who underwent abdominal Gd-EOB-DTPA - enhanced magnetic resonance imaging were collected. Univariate and multivariate logistic regression analyses were performed to determine AFs that could independently and significantly predict HCC. The modified LR-5 criteria involved reclassifying LR-4/LR-3 lesions based on major features combined with independently significant AFs for HCC, or by substituting threshold growth with significant AFs. McNemar's test was used to compare the diagnostic performance of the modified LR-5 criteria.
RESULTS
A total of 244 lesions from 216 patients were included. Transitional phase hypointensity, mild - moderate T2 hyperintensity, and fat in mass (more than adjacent liver) were identified as significant independent predictors of HCC. Using the modified LR-5 criteria (e.g., LR-5-M1: LR-4 + transitional phase hypointensity; LR-5-M4: LR-5 by transitional phase hypointensity instead of threshold growth; LR-5-M5: LR-5 by mild - moderate T2 hyperintensity instead of threshold growth; LR-5-M8: LR-3/LR-4 + any two features of transitional phase hypointensity/mild - moderate T2 hyperintensity/fat in mass), sensitivities were significantly increased (88.5%-89.1%) compared to the standard LR-5 (60.6%; all P values < 0.05), while specificities (84.8%-89.9%) remained largely unchanged (93.7%; all P values > 0.05). The LR-5-M8 criterion achieved the highest sensitivity.
CONCLUSION
Mild - moderate T2 hyperintensity, transitional phase hypointensity, and fat in mass are independent and significant predictors of HCC malignant AFs. The modified LR-5 criteria can improve sensitivity without significantly reducing specificity.
Core Tip: The LR-5 classification of Liver Imaging Reporting and Data System version 2018 can only be determined based on major features, which have high specificity but low sensitivity for the diagnosis of hepatocellular carcinoma. This study aims to identify independent and significant ancillary features and develop a modified LR-5 standard in Liver Imaging Reporting and Data System version 2018 based on gadoxetic acid. The modified LR-5 standard can improve the sensitivity of LR-5 without significantly reducing its original high specificity.
