Diagnostic performance of the LR-M criteria and spectrum of LI-RADS imaging features among primary hepatic carcinomas

• Published in: Abdominal imaging 2020-11, Vol.45 (11), p.3743-3754
• Main Authors: Kim, Seung-seob, Lee, Sunyoung, Choi, Jin-Young, Lim, Joon Seok, Park, Mi-Suk, Kim, Myeong-Jin
• Format: Article
• Language: English
• Subjects: Carcinoma; Cholangiocarcinoma; Criteria; Diagnostic systems; Gastroenterology; Hepatobiliary; Hepatocellular carcinoma; Hepatology; Imaging; Liver cancer; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Performance evaluation; Radiology; Risk analysis; Risk factors; Sensitivity; Subgroups; Tumors
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-020-02562-y

Purpose To evaluate the diagnostic performance of LR-M criteria for differentiating hepatocellular carcinoma, intrahepatic mass-forming cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma and to compare the imaging features of each type. Methods In this retrospective study, 110 patients were surgically diagnosed with cholangiocarcinoma ( n  = 67) and combined hepatocellular-cholangiocarcinoma ( n  = 43) at a single tertiary hospital between 2013 and 2018. Among them, those with risk factors were enrolled (16 cholangiocarcinomas and 33 combined hepatocellular-cholangiocarcinomas). Forty-nine other patients with size-matched hepatocellular carcinoma were selected as a control group. Two independent readers evaluated the imaging findings of the preoperative MRIs based on LI-RADS version 2018 and assigned an LI-RADS category. The diagnostic performance of the LR-M criteria for diagnosing cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma was evaluated, and the imaging features were compared. The imaging findings of the tumors in patients without risk factors (51 cholangiocarcinomas and 10 combined hepatocellular-cholangiocarcinomas) were evaluated for subgroup analysis. Results In the non-hepatocellular carcinoma group, 33 patients were categorized into LR-M and 14 patients into LR-5 (67.3% and 28.6%, respectively), while 5 patients with hepatocellular carcinoma were categorized into LR-M and 38 patients into LR-5 (10.2% and 77.6%, respectively). Sensitivity and specificity of the LR-M criteria were 67.3% and 89.8%, respectively. When more than two LR-M features were present, cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma were suggested with a specificity of 95.9%. Conclusion The diagnostic performance of the LR-M criteria is acceptable with moderate sensitivity and high specificity for both cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma. Imaging findings of primary hepatic carcinomas should be understood as a spectrum.