Modifying LI-RADS on Gadoxetate Disodium-Enhanced MRI: A Secondary Analysis of a Prospective Observational Study

J Magn Reson Imaging. 2022 Aug;56(2):399-412. doi: 10.1002/jmri.28056. Epub 2022 Jan 7.

Abstract

Background: The Liver Imaging Reporting and Data System (LI-RADS) is widely used for diagnosing hepatocellular carcinoma (HCC), however, with unsatisfactory sensitivity, complex ancillary features, and inadequate integration with gadoxetate disodium (EOB)-enhanced MRI.

Purpose: To modify LI-RADS (mLI-RADS) on EOB-MRI.

Study type: Secondary analysis of a prospective observational study.

Population: Between July 2015 and September 2018, 224 consecutive high-risk patients (median age, 51 years; range, 26-83; 180 men; training/testing sets: 169/55 patients) with 742 (median size, 13 mm; interquartile range, 7-27; 498 HCCs) LR-3/4/5 observations.

Field strength/sequence: 3.0 T T2 -weighted fast spin-echo, diffusion-weighted spin-echo based echo-planar, and 3D T1 -weighted gradient echo sequences.

Assessment: Three radiologists (with 5, 5, and 10 years of experience in liver MR imaging, respectively) blinded to the reference standard (histopathology or imaging follow-up) reviewed all MR images independently. In the training set, the optimal LI-RADS version 2018 (v2018) features selected by Random Forest analysis were used to develop mLI-RADS via decision tree analysis.

Statistical tests: In an independent testing set, diagnostic performances of mLI-RADS, LI-RADS v2018, and the Korean Liver Cancer Association (KLCA) guidelines were computed using a generalized estimating equation model and compared with McNemar's test. A two-tailed P < 0.05 was statistically significant.

Results: Five features (nonperipheral "washout," restricted diffusion, nonrim arterial phase hyperenhancement [APHE], mild-moderate T2 hyperintensity, and transitional phase hypointensity) constituted mLI-RADS, and mLR-5 was nonperipheral washout coupled with either nonrim APHE or restricted diffusion. In the testing set, mLI-RADS was significantly more sensitive (72%) and accurate (80%) than LI-RADS v2018 (sensitivity, 61%; accuracy 74%; both P < 0.001) and the KLCA guidelines (sensitivity, 64%; accuracy 74%; both P < 0.001), without sacrificing positive predictive value (mLI-RADS, 94%; LI-RADS v2018, 94%; KLCA guidelines, 92%).

Data conclusion: In high-risk patients, the EOB-MRI-based mLI-RADS was simpler and more sensitive for HCC than LI-RADS v2018 while maintaining high positive predictive value.

Level of evidence: 2 TECHNICAL EFFICACY: Stage 2.

Keywords: Liver Imaging Reporting and Data System; diagnosis; gadoxetate disodium; hepatocellular carcinoma; magnetic resonance imaging.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Hepatocellular* / diagnostic imaging
  • Contrast Media
  • Gadolinium DTPA
  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sensitivity and Specificity

Substances

  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA