Diagnostic performance of LI-RADS version 2018 in differentiating hepatocellular carcinoma from other hepatic malignancies in patients with hepatitis B virus infection

Shuo  Shao; Yingying  Liang; Sichi  Kuang; Jingbiao  Chen; Qungang  Shan; Hao  Yang; Yao  Zhang; Bin  Wang; Kathryn  J. Fowler; Jin Wang; Claude  B. Sirlin

doi:10.17305/bjbms.2019.4576

Shuo Shao Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China; Department of Radiology, Jining No.1 People's Hospital, Jining, China; Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, Jining, China https://orcid.org/0000-0003-4285-3274
Yingying Liang Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China; The Second Affiliated Hospital, South China University of Technology, Guangzhou, China https://orcid.org/0000-0002-1077-8671
Sichi Kuang Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China https://orcid.org/0000-0003-3674-651X
Jingbiao Chen Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China https://orcid.org/0000-0002-8573-709X
Qungang Shan Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China
Hao Yang Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China https://orcid.org/0000-0003-3149-8334
Yao Zhang Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China
Bin Wang Medical Imaging Research Institute, Binzhou Medical University, Yantai, China https://orcid.org/0000-0002-3590-8102
Kathryn J. Fowler Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA https://orcid.org/0000-0001-9188-1701
Jin Wang Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Guangzhou, China
Claude B. Sirlin Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA

DOI: https://doi.org/10.17305/bjbms.2019.4576

Keywords: Hepatocellular carcinoma, HCC, intrahepatic cholangiocarcinoma, ICCA, combined HCC-cholangiocarcinoma, cHCC-CCA, hepatitis B virus, HBV, Liver Imaging Reporting and Data System (LI-RADS)

Abstract

The diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) in differentiating hepatocellular carcinoma (HCC) from other hepatic malignancies has not been investigated in Chinese patients with chronic liver disease from hepatitis B virus (HBV) infection. The aim of this study was to evaluate the accuracy of the LI-RADS version 2018 in differentiating HCC, intrahepatic cholangiocarcinoma (ICCA), and combined HCC-cholangiocarcinoma (cHCC-CCA) in Chinese patients with HBV infection. Seventy consecutive HBV-infected patients with ICCA (n = 48) or cHCC-CCA (n = 22) who underwent contrast-enhanced magnetic resonance imaging (CE-MRI) between 2006 and 2017 were enrolled along with a comparison cohort of 70 patients with HCC and CE-MRI-matched for tumor size (10–19 mm, 20–30 mm, 31–50 mm, and >50 mm). Imaging feature frequencies for each tumor type were compared using Fisher’s exact test. The classification accuracy of LR-5 and LR-M was estimated for HCC versus non-HCC (ICCA and cHCC-CCA). The interobserver agreement was good for LI-RADS categories of HCC and moderate for non-HCC. After consensus read, 66 of 70 (94%) HCCs were categorized LR-5 (including tumor in vein [TIV] with LR-5), while 42 of 48 (88%) ICCAs and 13 of 22 (59%) cHCC-CCAs were categorized LR-M (including TIV with LR-M) (p < 0.001). Thus, assignment of LR-5 provided 94% sensitivity and 81% specificity for HCC. LR-M provided 79% sensitivity and 97% specificity for non-HCC (ICCA and cHCC-CCA); and the sensitivity and accuracy were lower in differentiating HCC from non-HCC (tumor size <20 mm). LI-RADS v2018 category 5 and M reliably differentiated HBV-related HCC from ICCA. However, a substantial proportion of cHCC-CCAs were categorized LR-5 rather than LR-M. While management is controversial for these combined tumors, accurate prospective differentiation is desired for optimal treatment.

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