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Comparison of Four Diagnostic Guidelines for Hepatocellular Carcinoma Using Gadoxetic Acid-enhanced Liver MRI

Authors
 Jeong Hee Yoon  ;  Young Kon Kim  ;  Jeong Woo Kim  ;  Won Chang  ;  Joon-Il Choi  ;  Beom Jin Park  ;  Jin-Young Choi  ;  Seung-Seob Kim  ;  Hee Sun Park  ;  Eun Sun Lee  ;  Jeong-Sik Yu  ;  Seong Jin Park  ;  Myung-Won You  ;  Chang Hee Lee  ;  Jeong Min Lee 
Citation
 RADIOLOGY, Vol.311(1) : e233114, 2024-04 
Journal Title
RADIOLOGY
ISSN
 0033-8419 
Issue Date
2024-04
MeSH
Carcinoma, Hepatocellular* / diagnostic imaging ; Gadolinium DTPA* ; Humans ; Liver Neoplasms* / diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies
Abstract
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.
Full Text
https://pubs.rsna.org/doi/10.1148/radiol.233114
DOI
10.1148/radiol.233114
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Yu, Jeong Sik(유정식) ORCID logo https://orcid.org/0000-0002-8171-5838
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/199133
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