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A New Reporting System for Diagnosis of Hepatocellular Carcinoma in Chronic Hepatitis B With Clinical and Gadoxetic Acid-Enhanced MRI Features

Authors
 Shin Hye Hwang  ;  Seung Baek Hong  ;  Kyunghwa Han  ;  Nieun Seo  ;  Jin-Young Choi  ;  Jei Hee Lee  ;  Sumi Park  ;  Young-Suk Lim  ;  Do Young Kim  ;  So Yeon Kim  ;  Mi-Suk Park 
Citation
 JOURNAL OF MAGNETIC RESONANCE IMAGING, Vol.55(6) : 1877-1886, 2022-06 
Journal Title
JOURNAL OF MAGNETIC RESONANCE IMAGING
ISSN
 1053-1807 
Issue Date
2022-06
MeSH
Carcinoma, Hepatocellular* / diagnostic imaging Carcinoma, Hepatocellular* / pathology Contrast Media Gadolinium DTPA Hepatitis B, Chronic* / complications Hepatitis B, Chronic* / diagnostic imaging Humans Liver Neoplasms* / diagnostic imaging Liver Neoplasms* / pathology Magnetic Resonance Imaging / methods Retrospective Studies Sensitivity and Specificity
Keywords
carcinoma ; diagnosis ; gadolinium DTPA ; hepatocellular ; magnetic resonance imaging
Abstract
Background: Current major guidelines for diagnosis of hepatocellular carcinoma (HCC) based on imaging findings are different from each other and do not include clinical risk factors as a diagnostic criteria.

Purpose: To developed and validated a new diagnostic score system using MRI and clinical features as applied in chronic hepatitis B patients.

Study type: Retrospective observational study.

Subject: A total of 418 treatment-naïve patients (out of 902 patients) with chronic hepatitis B having 556 lesions suspected for HCC which were eligible for curative treatment.

Field strength/sequence: T1W GRE in- and opposed-phase, T2W FSE, DWI, and T1W 3D-GRE dynamic contrast-enhanced sequences at 1.5 T and 3 T.

Assessment: Six radiologists with 7-22 years of experience independently evaluated MR images based on Liver Imaging Reporting and Data System (LI-RADS) version 2018.

Statistical tests: Based on logistic regression analysis of MRI features and clinical factors, a risk score system was devised in derivation cohorts (268 patients, 352 lesions) and externally validated (150 patients, 204 lesions). The performance of the new score system was assessed by Harell's c-index. Using cutoff value of 12, maintaining positive predictive value ≥95%, the diagnostic performances of the score system were compared with those of LR-5.

Results: The 15-point diagnostic scoring system used MRI features (lesion size, nonrim arterial phase hyperenhancement, portal venous phase hypointensity, hepatobiliary phase hypointensity, and diffusion restriction) and clinical factors (alpha-fetoprotein and platelet). It showed good discrimination in the derivation (c-index, 0.946) and validation cohorts (c-index, 0.907). Using a risk score of 12 as a cut-off, this system yielded higher sensitivity than LR-5 (derivation cohort, 76.8% vs. 52.1%; validation cohort, 73.4% vs. 49.5%) without significant decrease in specificity (derivation cohort, 93.1% vs. 97.2%, P = 0.074; validation cohort, 91.7% vs. 96.1%, P = 0.299).

Data conclusion: A new score system showed improved sensitivity in chronic hepatitis B patients compared to LI-RADS without significant compromise in specificity. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.
Full Text
https://onlinelibrary.wiley.com/doi/10.1002/jmri.27962
DOI
10.1002/jmri.27962
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
Han, Kyung Hwa(한경화)
Hwang, Shin Hye(황신혜)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/191572
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