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MRI Ancillary Features for LI-RADS Category 3 and 4 Observations: Improved Categorization to Indicate the Risk of Hepatic Malignancy

 Yeun-Yoon Kim  ;  Jin-Young Choi  ;  Seung Up Kim  ;  Myeongjee Lee  ;  Mi-Suk Park  ;  Yong Eun Chung  ;  Myeong-Jin Kim 
 AMERICAN JOURNAL OF ROENTGENOLOGY, Vol.215(6) : 1354-1362, 2020-12 
Journal Title
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MRI ; follow-up studies ; hepatocellular carcinoma ; liver neoplasms ; risk assessment
OBJECTIVE. The purpose of this study was to investigate whether ancillary features can help stratify malignancy risk in Liver Imaging Reporting and Data System (LI-RADS) category 3 (LR-3) and 4 (LR-4) observations. MATERIALS AND METHODS. This retrospective longitudinal study included 106 LR-3 or LR-4 observations on gadolinium-enhanced MRI obtained from January 2014 to December 2015 in 80 patients who were treatment naïve and at risk (mean age, 58.0 ± 10.7 [SD] years; 60 men). The presence of major and ancillary features, the category determined using only major features, and the final category adjusted by the application of ancillary features were retrospectively analyzed. MRI features were compared using generalized estimating equations, and cumulative incidence curves for malignancy were compared using log-rank tests with a resampling extension. RESULTS. At 6-month follow-up, the cumulative incidence of observations initially categorized as LR-4, observations upgraded to LR-4, observations initially categorized as LR-3, and observations downgraded to LR-3 were 62.5%, 29.7%, 6.2%, and 0%, respectively. The cumulative incidence of malignancy did not differ between observations categorized by major feature as LR-3 and LR-4 (p = 0.12), but was higher in final observations categorized as LR-4 than in those categorized as LR-3 (p < 0.001). Among observations categorized by major feature as LR-3, the cumulative incidence of malignancy was higher in observations upgraded to LR-4 than in observations that were initially graded as LR-3 (p = 0.03), which showed differences in the frequency of restricted diffusion and mild-to-moderate T2-weighted hyperintensity (p < 0.001 for both). CONCLUSION. Final categories determined with ancillary features, instead of categories determined by major features only, can help indicate malignancy risk in LR-3 and LR-4 observations on MRI.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Yeun-Yoon(김연윤) ORCID logo https://orcid.org/0000-0003-2018-5332
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Lee, Myeongjee(이명지)
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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