LI-RADS Classification and Prognosis of Primary Liver Cancers at Gadoxetic Acid-enhanced MRI
- Authors
- Choi, Sang Hyun; Lee, Seung Soo; Park, So Hyun; Kim, Kang Mo; Yu, Eunsil; Park, Yangsoon; Shin, Yong Moon; Lee, Moon-Gyu
- Issue Date
- Feb-2019
- Publisher
- RADIOLOGICAL SOC NORTH AMERICA
- Citation
- RADIOLOGY, v.290, no.2, pp.388 - 397
- Journal Title
- RADIOLOGY
- Volume
- 290
- Number
- 2
- Start Page
- 388
- End Page
- 397
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/1888
- DOI
- 10.1148/radiol.2018181290
- ISSN
- 0033-8419
- Abstract
- Purpose: To (a) evaluate the postsurgical prognostic implication of the Liver Imaging Reporting and Data System (LI-RADS) categories of primary liver cancers and (b) determine the performance of LI-RADS version 2017 in differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (IHCC) and combined hepatocellular-cholangiocarcinoma (cHCC-CC) at gadoxetic acid-enhanced MRI. Materials and Methods: In this retrospective study, 194 patients with cirrhosis and surgically proven single primary liver cancer (53 with cHCC-CC, 44 with IHCC, and 97 with HCC) were evaluated with gadoxetic acid-enhanced MRI between 2009 and 2014. The mean patient age was 57 years (age range, 30-83 years). There were 155 men with a mean age of 56 years (range, 30-81 years) and 39 women with a mean age of 58 years (range, 38-83 years). Two independent readers assigned an LI-RADS category for each nodule. Overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated by using the Kaplan-Meier method, log-rank test, and Cox proportional hazard model. Results: In the multivariable analysis, the LI-RADS category was an independent factor for OS (hazard ratio, 4.2; P<.001) and RFS (hazard ratio, 2.6; P =.01). The LR-M category showed more correlation with poorer OS and RFS than did the LR-4 or LR-5 category for all primary liver cancers (P<.001 for both), HCCs (P =.01 and P<.001, respectively), and cHCC-CCs (P =.01 and P =.03, respectively). The LR-5 category had a sensitivity of 69% (67 of 97) and a specificity of 87% (84 of 97) in the diagnosis of HCC; most false-positive diagnoses (85%, 11 of 13) were the result of misclassification of cHCC-CCs. Conclusion: The Liver Imaging Reporting and Data System (LI-RADS) category was associated with postsurgical prognosis of primary liver cancers, independent of pathologic diagnosis. The LI-RADS enabled the correct classification of most hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinomas, whereas differentiation of combined hepatocellular-cholangiocarcinoma from HCC was unreliable. (c) RSNA, 2018
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