Highlights
- •The frequency of threshold growth, determined by LI-RADS v2018 was 18.8%.
- •Threshold growth was significantly associated with HCC.
- •Use of threshold growth as a major feature improved the sensitivity of HCC detection by LI-RADS v2018.
Background & Aims
The Liver Reporting and Data System (LI-RADS) version 2018 simplified the definition
of threshold growth to ‘≥50% size increase in a mass in ≤6 months’. However, the diagnostic
value of threshold growth for hepatocellular carcinoma (HCC) remained unclear. We
evaluated the value of threshold growth, as defined by LI-RADS v2018, in diagnosing
HCCs.
Methods
Patients who underwent preoperative gadoxetate disodium-enhanced MRI because of the
presence of LI-RADS category 2, 3, or 4 rather than category 5 on prior CT/MRI between
January 2017 and December 2020 were retrospectively evaluated. Pathologic or clinical
diagnoses were used as reference standards. Imaging features were evaluated by three
readers according to LI-RADS v2018. The frequency and diagnostic odds ratio of threshold
growth were calculated. The diagnostic performance of LI-RADS category 5 was separately
evaluated when threshold growth was and was not considered a major feature, and results
were compared using generalized estimation equations. Subgroups of patients who underwent
CT/MRI during the previous 3–6 months were analyzed.
Results
Analysis of 340 observations in 243 patients found that the frequency of threshold
growth was 18.8% and it gradually increased over time. Threshold growth was significantly
associated with HCC (diagnostic odds ratio 5.2; 95% CI 2.1–12.7; p <0.001). Use of threshold growth as a major feature significantly increased sensitivity
in both the overall (66.4% vs. 57.3%, p <0.001) and subgroup (73.4% vs. 58.2%, p <0.001) cohorts, but had no effect on specificity in either the overall (97.5% vs. 98.3%, p = 0.319) or subgroup (95.9% vs. 98.0%, p = 0.323) cohorts.
Conclusion
The revised threshold growth of LI-RADS v2018 was significantly associated with HCC.
Use of threshold growth as a major diagnostic feature of HCC can improve the sensitivity
of LI-RADS v2018.
Impact and implications
We found that the revised threshold growth in the Liver Imaging Reporting and Data
System version 2018 (LI-RADS v2018) was a significant predictor of hepatocellular
carcinoma (HCC). The use of threshold growth as a major imaging feature of HCC significantly
increased the sensitivity of LI-RADS v2018, especially small HCCs (≤3.0 cm), compared
with its non-use. Because these small HCCs are eligible for curative treatments, the
additional detection of small HCCs is clinically meaningful.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 15, 2022
Accepted:
November 1,
2022
Received in revised form:
October 17,
2022
Received:
March 22,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Author names in bold designate shared co-first authorship.
Identification
Copyright
© 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
