Hepatocellular Carcinoma versus Other Hepatic Malignancy in Cirrhosis: Performance of LI-RADS Version 2018
Menée à partir de données portant sur 220 patients atteints d'une cirrhose du foie, dont 165 atteints d'un carcinome hépatocellulaire et 55 d'un autre type de tumeur hépatique (âge moyen : 58 ans ; 41 femmes), cette étude évalue la performance de la version 2018 du système de score LI-RADS pour distinguer, à partir des résultats des examens d'imagerie (échographie, tomographie numérique ou IRM), un carcinome hépatocellulaire d'autres types de cancer hépatique chez les patients atteints d'une cirrhose
Background : The LR-5 and LR-M criteria provide comparable performances for differentiating between hepatocellular carcinoma and other hepatic malignancy with the Liver Imaging Reporting and Data System, or LI-RADS, version 2018.
Purpose : To evaluate the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 for differentiating between hepatocellular carcinoma (HCC) and other (hepatic) malignancy (OM) in patients with liver cirrhosis.
Materials and Methods : From 2008 to 2017, 55 patients with untreated OM and liver cirrhosis were eligible for this retrospective case-control study (mean age, 58 years ± 10 [standard deviation] [range, 32−79 years], with 45 men [mean age, 58 years ± 11] and 10 women [mean age, 62 years ± 7]). Control subjects consisted of 165 treatment-naive patients with HCC and liver cirrhosis (mean age, 58 years ± 10 [range, 29−80 years], with 134 men [mean age, 58 years ± 9] and 31 women [mean age, 59 years ± 11]). Two radiologists blinded to the final diagnosis independently determined the presence of LR-M features and major HCC features (non-rim arterial phase hyperenhancement, non-peripheral washout, and enhancing capsule). The diagnostic performances of each feature, the LR-M criteria (probably or definitely malignant, but not specific for HCC), and the LR-5 criteria (definitely HCC) were calculated and compared by using the generalized estimating equation method.
Results : Individual LR-M features had a sensitivity of 9%−71% and a specificity of 83%−97% for the diagnosis of OM. Major features of HCC had a sensitivity of 62%−83% and a specificity of 69%−89% for the diagnosis of HCC. The LR-M criteria had a sensitivity of 89% (95% confidence interval [CI]: 81%, 97%) for diagnosing OM, with a specificity of 48% (95% CI: 40%, 56%). The LR-5 criteria had a sensitivity of 74% (95% CI: 67%, 81%) for diagnosing HCC, with a specificity of 89% (95% CI: 81%, 97%). The accuracy of the LR-5 criteria was higher than that of the LR-M criteria (78% [95% CI: 72%, 83%] vs 58% [95% CI: 52%, 65%], P <. 001).
Conclusion : The LR-5 criteria as well as the LR-M criteria can effectively distinguish hepatocellular carcinoma from other hepatic malignancy in patients with liver cirrhosis.
Radiology , résumé, 2018