The role of lesion hypointensity on gadobenate dimeglumine–enhanced hepatobiliary phase MRI as an additional major imaging feature for HCC classification using LI-RADS v2018 criteria

• Published in: European radiology 2021-10, Vol.31 (10), p.7715-7724
• Main Authors: Zhang, Yao, Tang, Wenjie, Xie, Sidong, Chen, Jingbiao, Zhang, Linqi, Rong, Dailin, Kuang, Sichi, He, Bingjun, Wang, Jin
• Format: Article
• Language: English
• Subjects: Classification; Criteria; Diagnostic Radiology; Diagnostic systems; Hepatobiliary-Pancreas; Hepatocellular carcinoma; Imaging; Internal Medicine; Interventional Radiology; Lesions; Liver cancer; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Nodules; Radiology; Sensitivity; Sensitivity analysis; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-07807-y

Objectives To determine the value of lesion hypointensity in the hepatobiliary phase (HBP) on gadobenate dimeglumine–enhanced MRI as an additional major imaging feature for diagnosis of hepatocellular carcinoma (HCC) using LI-RADS v2018 criteria. Methods Between March 2016 and August 2018, 235 patients with 250 hepatic nodules at high risk of HCC underwent gadobenate dimeglumine–enhanced MRI. Two radiologists independently evaluated the imaging features and classified the nodules based on LI-RADS v2018 criteria, and their consensus data were used to calculate the diagnostic performance of LI-RADS categories. Two modified LI-RADS definitions were as follows: (1) LI-RADS-m1: HBP hypointensity as an additional major feature; (2) LI-RADS-m2: HBP hypointensity as an alternative to “enhancing capsule” as an additional major feature. The diagnostic performance of LR-5 categories was compared using McNemar’s test. Results The sensitivity and specificity for LR-5 classification using original LI-RADS v2018 criteria were 78.1% and 96.3%, respectively. Significantly improved sensitivity (82.7%; p = 0.004) with unchanged specificity (96.3%; p = 1.00) was seen for LR-5 classification using LI-RADS-m1. Similar sensitivity and specificity (82.7% and 96.3%, respectively) were also seen using LI-RADS-m2. Significantly improved sensitivity (79.5% vs. 64.0%; p = 0.031) with unchanged specificity (96.2% vs. 96.2%, p = 1.00) was seen using both LI-RADS-m1 and LI-RADS-m2 compared to the original LI-RADS v2018 for 39 HCC nodules measuring 10–19 mm. Conclusions Lesion hypointensity on gadobenate dimeglumine–enhanced HBP MRI may improve sensitivity for LR-5 classification beyond that achievable using conventional LI-RADS v2018 criteria. Lesion hypointensity may prove a suitable alternative imaging feature to enhancing capsule for accurate LR-5 classification. Key Points • Including lesion hypointensity in the HBP as an additional major feature improved sensitivity for LR-5 classification on gadobenate dimeglumine–enhanced MRI. • Lesion hypointensity in the HBP can replace “enhancing capsule” as an additional major feature for LR-5 classification without impairing specificity.