Modified LR-5 criteria based on gadoxetic acid can improve the sensitivity in the diagnosis of hepatocellular carcinoma

doi:10.4329/wjr.v17.i3.103822

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 3

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (163)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-3) series, Tables (1-4) series.

Item

Count

PDF

HTML

Figures (1-3)

Tables (1-4)

Sum=102

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=46

Publishing Process of This Article

Item

Count

Browse

Download

Sum=5

Mar 28, 2025 (publication date) through Mar 30, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Radiology

ISSN

1949-8470

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Radiol. Mar 28, 2025; 17(3): 103822
Published online Mar 28, 2025. doi: 10.4329/wjr.v17.i3.103822

Table 1 Clinical and pathological characteristics of study patients, n (%)

Variables		Values
Number of patients		216
Age (years), mean ± SD		58.69 ± 13.50
Sex	Male	152 (70.4)
Sex	Female	64 (29.6)
Cause of liver disease	HBV	189 (87.5)
	HCV	7 (3.2)
	ALD	8 (3.7)
	NAFLD	2 (0.9)
	SC	5 (2.3)
	Others	5 (2.3)
Number of lesions		244
Size of lesions (cm)		4.51 ± 3.37
Size subgroup	< 20 mm	76 (31.1)
Size subgroup	≥ 20 mm	168 (68.9)
Final diagnosis	HCC	165 (67.6)
	Non-HCC malignancy	24 (9.8)
	Intrahepatic cholangiocarcinoma	17 (7)
	NET G3	3 (1.2)
	Combined hepatocellular-cholangiocarcinoma	2 (0.8)
	Metastasis	2 (0.8)
	Benign lesion	55 (22.5)
	Hemangioma	19 (7.8)
	RN/DN	17 (6.9)
	FNH	9 (3.7)
	Liver abscess	6 (2.5)
	Angiomyolipoma	2 (0.8)
	Nodule of necrosis	1 (0.4)
	Hepatic schistosomiasis	1 (0.4)
Standard reference of diagnosis	Pathologic diagnosis of surgery	117 (48.0)
	Pathologic diagnosis of needle biopsy	85 (34.8)
	Typical imaging features with size stability (2 years)	42 (17.2)
LI-RADS category	LR-1	0 (0)
	LR-2	14 (5.7)
	LR-3	25 (10.2)
	LR-4	68 (27.9)
	LR-5	105 (43.0)
	LR-M	27 (11.1)
	LR-TIV	5 (2.0)

HBV: Hepatitis B; HCV: Hepatitis C; ALD: Alcoholic liver disease; NAFLD: Nonalcoholic fatty liver disease; SC: Schistosomal cirrhosis; NET: Neuroendocrine tumor; RN: Regenerative nodule; DN: Dysplastic nodule; FNH: Focal nodular hyperplasia-like nodule; LI-RADS: Liver Imaging Reporting and Data System.

Table 2 Liver Imaging Reporting and Data System features consistency of assessment among different radiologists, n (%)

LI-RADS features	Reader 1	Reader 2	Reader 3	Reader 1 vs reader 2, k value (95%CI)	Reader 1 vs reader 3, k value (95%CI)	Reader 2 vs reader 3, k value (95%CI)	Kendall's W
Nonrim APHE	204 (83.6)	174 (71.4)	203 (83.3)	0.67 (0.35-0.65)	0.81 (0.39-0.76)	0.73 (0.15-0.54)	0.81
Nonperipheral washout	163 (67.8)	155 (63.5)	150 (61.5)	0.83 (0.77-0.94)	0.87 (0.78-0.96)	0.77 (0.66-0.87)	0.79
Enhancing capsule	116 (47.5)	105 (43.0)	120 (49.2)	0.47 (0.33-0.66)	0.37 (0.31-0.51)	0.23 (0.11-0.27)	0.52
Threshold growth	7 (2.9)	5 (2.0)	6 (2.5)	1	1	1	1
Mosaic architecture	106 (43.4)	108 (44.3)	125 (51.3)	0.86 (0.83-0.97)	0.85 (0.71-0.94)	0.69 (0.67-0.83)	0.89
Non-enhancing capsule	21 (8.6)	21 (8.6)	21 (8.6)	0.71 (0.42-0.98)	0.71 (0.42-0.98)	0.71 (0.42-0.98)	0.79
Blood products in mass	100 (41.0)	82 (33.6)	76 (31.1)	0.87 (0.73-0.91)	0.89 (0.87-0.99)	0.90 (0.86-0.97)	0.93
Fat in mass-more than adjacent liver	82 (33.6)	86 (35.2)	90 (36.9)	0.83 (0.71-0.94)	0.81 (0.73-0.93)	0.73 (0.61-0.86)	0.83
Nodule-in-nodule architecture	83 (34.0)	78 (32.0)	72 (29.5)	0.71 (0.61-0.79)	0.67 (0.59-0.71)	0.59 (0.52-0.63)	0.65
Corona enhancement	42 (17.2)	56 (23.0)	53 (21.7)	0.81 (0.71-0.89)	0.83 (0.71-0.95)	0.78 (0.65-0.91)	0.83
Restricted diffusion	211 (86.5)	217 (88.9)	207 (84.8)	0.81 (0.65-0.91)	0.77 (0.61-0.89)	0.80 (0.66-0.95)	0.85
Mild-moderate T2 hyperintensity	213 (87.3)	200 (82.0)	202 (82.8)	0.75 (0.61-0.97)	0.71 (0.60-0.97)	0.73 (0.15-0.73)	0.81
Fat sparing in solid mass	15 (6.1)	29 (11.9)	31 (12.7)	0.61 (0.41-0.82)	0.64 (0.41-0.86)	0.45 (0.21-0.68)	0.71
Iron sparing in solid mass	44 (18.0)	38 (15.6)	40 (16.4)	0.31 (0.11-0.47)	0.33 (0.17-0.52)	0.37 (0.19-0.61)	0.55
Transitional phase hypointensity	229 (93.9)	225 (92.2)	230 (94.3)	0.73 (0.51-0.90)	0.71 (0.61-0.83)	0.70 (0.51-0.83)	0.87
Hepatobiliary phase hypointensity	223 (91.4)	225 (92.2)	225 (92.2)	0.81 (0.78-0.95)	0.82 (0.77-0.95)	0.87 (0.53-0.92)	0.89
Subthreshold growth	18 (7.4)	19 (7.8)	19 (7.8)	0.84 (0.67-1.01)	0.89 (0.74-1.04)	0.84 (0.67-1.01)	0.91

LI-RADS: Liver Imaging Reporting and Data System; CI: Confidence interval; APHE: Arterial phase hyperenhancement.

Table 3 Diagnostic performance and logistic regression analyses of major features and ancillary features favoring malignancy in Liver Imaging Reporting and Data System version 2018 for diagnosing hepatocellular carcinoma

Features	Diagnostic performance (%)		Univariable analysis		Multivariable analysis
Features	Sensitivity	Specificity	OR (95%CI)	P value	OR (95%CI)	P value
Major features
Size of lesions (≤ 20 mm; > 20 mm)	73.3 (121/165)	40.5 (32/79)	1.872(1.063-3.299)	0.029^a	0.969 (0.281-3.339)	0.960
Nonrim APHE	88.5 (146/165)	49.4 (39/79)	7.492(3.910-14.357)	0.000^a	18.913 (5.437-65.788)	0.000^b
Nonperipheral “washout”	58.8 (97/165)	88.6 (70/79)	11.095 (5.188-23.727)	0.000^a	3.443 (0.920-12.887)	0.006^b
Threshold growth	1.2 (2/165)	96.2 (76/79)	0.311(0.051-1.899)	0.395	-	-
Enhancing “capsule”	49.7 (82/165)	94.9 (75/79)	18.524 (6.475-52.991)	0.000^a	7.126 (1.209-42.004)	0.030^b
Malignant ancillary features favoring HCC
Mosaic architecture	51.5 (85/165)	74.7 (59/79)	3.134 (1.734-5.665)	0.000^a	0.687 (0.188-2.516)	0.571
Nonenhancing “capsule”	4.2 (7/165)	96.2 (76/79)	1.122 (0.282-4.461)	1.000	-	-
Blood products in mass	38.2 (63/165)	91.1 (73/79)	6.353 (2.751-14.673)	0.000^a	1.833 (0.385-8.730)	0.446
Fat in mass, more than adjacent liver	30.3 (50/165)	89.9 (71/79)	3.859 (1.729-8.612)	0.000^a	9.846 (2.042-47.467)	0.004^b
Nodule-in-nodule	30.3 (50/165)	93.7 (74/79)	6.435 (2.453-16.883)	0.000^a	0.995 (0.200-4.949)	0.995
Favoring malignancy in general
Corona enhancement	15.2 (25/165)	84.8 (67/79)	0.997 (0.472-2.105)	0.994	-	-
Restricted diffusion	86.7 (143/165)	57.0 (45/79)	8.603 (4.571-16.190)	0.000^a	0.697 (0.142-3.432)	0.658
Mild-moderate T2 hyperintensity	95.2 (157/165)	86.3 (50/79)	33.836 (14.535-78.766)	0.000^a	13.516 (2.568-71.131)	0.002^b
Fat sparing in solid mass	4.8 (8/165)	98.7 (78/79)	3.975 (0.488-32.344)	0.305	-	-
Iron sparing in solid mass	6.1 (10/165)	96.2 (76/79)	1.634 (0.437-6.113)	0.666	-
Transitional phase hypointensity	93.9 (155/165)	68.4 (54/79)	33.480 (15.103-74.219)	0.000^a	43.403 (10.479-179.770)	0.000^b
Hepatobiliary phase hypointensity	93.3 (154/165)	32.9 (26/79)	6.868 (3.177-14.848)	0.000^a	0.999 (0.230-4.344)	0.999
Subthreshold growth	5.5 (9/165)	94.9 (75/79)	1.082 (0.323-3.626)	1.000	-	-

^aP < 0.2 in univariable analysis.

^bP < 0.05 in multivariable analysis.

OR: Odds ratio; CI: Confidence intervals; APHE: Arterial phase hyperenhancement; HCC: Hepatocellular carcinoma.

Table 4 Diagnostic performances of various criteria using upgraded LR-5 for the noninvasive diagnosis of hepatocellular carcinoma

Diagnostic criteria	Upgrade number	Total/final number	Sensitivity% (95%CI)	P value²	Specificity% (95%CI)	P value²
LR-5	-	105/244	60.6 (0.532-0.681)	-	93.7 (0.883-0.990)	-
LR-5-M1¹	51	156/244	89.1 (0.843-0.938)	0.000	88.6 (0.816-0.956)	0.263
LR-5-M2	54	159/244	87.9 (0.829-0.929)	0.000	82.3 (0.739-0.907)	0.028
LR-5-M3	16	121/244	67.9 (0.608-0.750)	0.168	88.6 (0.816-0.956)	0.263
LR-5-M4¹	50	155/244	88.5 (0.836-0.934)	0.000	88.6 (0.816-0.956)	0.263
LR-5-M5¹	53	158/244	88.5 (0.836-0.934)	0.000	84.8 (0.769-0.927)	0.072
LR-5-M6	17	122/244	68.5 (0.614-0.756)	0.135	88.6 (0.816-0.956)	0.263
LR-5-M7	11	116/244	67.3 (0.601-0.744)	0.207	93.7 (0.883-0.990)	1.000
LR-5-M8¹	50	155/244	89.1 (0.843-0.938)	0.000	89.9 (0.832-0.965)	0.385
LR-5-M9	70	175/244	91.5 (0.873-0.958)	0.000	69.6 (0.595-0.798)	0.000

¹By using these alternative criteria, the sensitivities were significantly increased in varying degrees, whereas specificities were not significantly different compared with the standard LR-5.

²In comparison with the standard LR-5 of LI-RADS v2018.

M: Modified; LR-5-M1: LR-4 by major features alone + TP hypointensity; LR-5-M2: LR-4 by major features alone + mild-moderate T2 hyperintensity; LR-5-M3: LR-4 by major features alone + fat in mass, more than adjacent liver; LR-5-M4: Transition phase (TP) hypointensity substitute threshold growth; LR-5-M5: Mild-moderate T2 hyperintensity substitute threshold growth; LR-5-M6: Fat in mass, more than adjacent liver substitute threshold growth; LR-5-M7: LR-3/LR-4 by major features alone + TP hypointensity + mild-moderate T2 hyperintensity + fat in mass, more than adjacent liver; LR-5-M8: LR-3/LR-4 by major features alone + any two features of TP hypointensity, mild-moderate T2 hyperintensity and fat in mass, more than adjacent liver; LR-5-M9: LR-3/LR-4 by major features alone + anyone features of TP hypointensity, mild-moderate T2 hyperintensity and fat in mass, more than adjacent liver; CI: Confidence intervals.

Citation: 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
URL: https://www.wjgnet.com/1949-8470/full/v17/i3/103822.htm
DOI: https://dx.doi.org/10.4329/wjr.v17.i3.103822