Background

Noninvasive diagnostic guidelines for hepatocellular carcinoma (HCC) vary across different global geographic areas, especially regarding criteria about gadoxetic acid–enhanced MRI.

Purpose

To compare the diagnostic performance of four different international HCC diagnosis guidelines and readers’ judgment in diagnosing HCC using gadoxetic acid–enhanced MRI in patients at high risk for HCC.

Materials and Methods

This retrospective study included patients who had not undergone treatment, were at risk for HCC, and who underwent gadoxetic acid–enhanced MRI from January 2015 to June 2018 from 11 tertiary hospitals in South Korea. Four radiologists independently reviewed focal liver lesions (FLLs) according to four guidelines: American Association for the Study of Liver Diseases (AASLD)/Liver Imaging Reporting and Data System (LI-RADS), Korean Liver Cancer Association–National Cancer Center (KLCA-NCC), European Association for the Study of the Liver (EASL), and Asian Pacific Association for the Study of the Liver (APASL). Reader judgment (HCC or not HCC) was also recorded. Malignant FLLs were confirmed at pathology, and histologic and clinical follow-up data were used for benign FLLs. The guidelines’ diagnostic performance was compared using generalized estimating equations. Additionally, the diagnostic odds ratio was assessed.

Results

A total of 2445 FLLs (median size, 27.4 mm) were analyzed in 2237 patients (mean age, 59 years ± 11 [SD]; 1666 male patients); 69.3% (1694 of 2445) were HCCs. KLCA-NCC showed the highest accuracy (80.0%; 95% CI: 78.7, 81.2; P = .001), with high sensitivity in Eastern guidelines (APASL, 89.1% [95% CI: 87.8, 90.3]; KLCA-NCC, 78.2% [95% CI: 76.6, 79.7]) and high specificity in Western guidelines (AASLD/LI-RADS, 89.6% [95% CI: 87.8, 91.2]; EASL, 88.1% [95% CI: 86.2, 89.9]) (P = .001). The diagnostic odds ratios were 20.7 (95% CI: 17.0, 25.3) for AASLD/LI-RADS, 18.9 (95% CI: 15.8, 22.6) for KLCA-NCC, 16.8 (95% CI: 13.8, 20.4) for EASL, and 8.9 (95% CI: 7.4, 10.7) for APASL. The readers’ judgment demonstrated higher accuracy than that of the guidelines (accuracy, 86.0%; 95% CI: 84.9, 86.9; P = .001).

Conclusion

Among four different international HCC diagnosis guidelines, Eastern guidelines demonstrated higher sensitivity, whereas Western guidelines displayed higher specificity. KLCA-NCC achieved the highest accuracy, and AASLD/LI-RADS exhibited the highest diagnostic odds ratio.

© RSNA, 2024

Supplemental material is available for this article.

中文翻译：

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钆塞酸增强肝脏 MRI 四种肝细胞癌诊断指南的比较

 背景

全球不同地理区域的肝细胞癌 (HCC) 无创诊断指南各不相同，特别是关于钆塞酸增强 MRI 的标准。

 目的

比较四种不同的国际 HCC 诊断指南的诊断性能以及读者使用钆塞酸增强 MRI 对 HCC 高危患者诊断 HCC 的判断。

 材料和方法

这项回顾性研究纳入了 2015 年 1 月至 2018 年 6 月期间在韩国 11 家三级医院接受过钆塞酸增强 MRI 的未接受治疗、有 HCC 风险的患者。四位放射科医生根据以下四项指南独立审查了局灶性肝脏病变 (FLL)：美国肝病研究协会 (AASLD)/肝脏成像报告和数据系统 (LI-RADS)、韩国肝癌协会国家癌症中心 (KLCA- NCC）、欧洲肝脏研究协会（EASL）和亚太肝脏研究协会（APASL）。还记录了读者的判断（HCC 或非 HCC）。恶性 FLL 经病理学证实，组织学和临床随访数据用于良性 FLL。使用广义估计方程来比较指南的诊断性能。此外，还评估了诊断比值比。

 结果

共分析了 2237 名患者（平均年龄 59 岁 ± 11 [SD]；1666 名男性患者）的 2445 个 FLL（中位大小 27.4 毫米）； 69.3%（2445 例中的 1694 例）为 HCC。 KLCA-NCC 显示出最高的准确度（80.0%；95% CI：78.7, 81.2； P = .001），在东部指南中具有高灵敏度（APASL，89.1% [95% CI: 87.8, 90.3]；KLCA-NCC， 78.2% [95% CI: 76.6, 79.7]) 和西方指南中的高特异性 (AASLD/LI-RADS, 89.6% [95% CI: 87.8, 91.2]；EASL, 88.1% [95% CI: 86.2, 89.9] ）（ P = .001）。 AASLD/LI-RADS 的诊断比值比为 20.7 (95% CI: 17.0, 25.3)，KLCA-NCC 为 18.9 (95% CI: 15.8, 22.6)，EASL 为 16.8 (95% CI: 13.8, 20.4)， APASL 为 8.9（95% CI：7.4、10.7）。读者的判断比指南的准确度更高（准确度，86.0%；95% CI：84.9、86.9； P = .001）。

 结论

在四种不同的国际HCC诊断指南中，东方指南表现出较高的敏感性，而西方指南表现出较高的特异性。 KLCA-NCC 实现了最高的准确率，AASLD/LI-RADS 表现出最高的诊断比值比。

 © 北美放射学会，2024

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