Diagnostic performance of Liver Imaging Reporting and Data System in patients at risk of both hepatocellular carcinoma a
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HEPATOBILIARY
Diagnostic performance of Liver Imaging Reporting and Data System in patients at risk of both hepatocellular carcinoma and metastasis Min Jeong Cho1 · Chansik An1 · Khalid Suliman Aljoqiman1,2 · Jin‑Young Choi1 · Joon Seok Lim1 · Mi‑Suk Park1 · Hyungjin Rhee1 · Myeong‑Jin Kim1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective The purpose of this study was to evaluate the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) in patients with both chronic liver disease and a history of extrahepatic malignancy. Materials and methods This retrospective study included 59 hepatocellular carcinomas (HCCs) and 45 metastases pathologically confirmed between 2008 and 2017 in 104 patients with chronic liver disease (cirrhosis or chronic hepatitis B) and a history of extrahepatic malignancy. Two radiologists blinded to the final diagnosis independently reviewed MRI (95 patients) or CT (9 patients) images, and their consensus data were used to calculate the diagnostic performance of LI-RADS categories. Serum tumor markers, tumor multiplicity, and suspected metastatic lymph nodes were also evaluated. Results The sensitivity, specificity, and accuracy of LR-5 for diagnosing HCC were 69% (95% confidence intervals [CI] 56–81), 98% (95% CI 88–99), and 82% (95% CI 73–89), respectively, and those of LR-M for diagnosing metastasis were 89% (95% CI 76–96), 88% (95% CI 77–95), and 88% (95% CI 81–94), respectively. Elevation of serum carcinoembryonic antigen (P = 0.01) or carbohydrate antigen 19–9 levels (P = 0.02) and tumor multiplicity (P = 0.004) were more frequently observed in metastasis than in HCC. Three of four metastases categorized as LR-4 or LR-5 were smaller than 2 cm. Conclusions The LI-RADS provides high specificity (98%) for differentiating HCC from metastases in patients with both chronic liver disease and a history of extrahepatic malignancy. Keywords Liver neoplasms · Differential diagnosis · Liver cirrhosis · Magnetic resonance imaging · Contrast media · Database management systems
Introduction
We present two first authors, Min Jeong Cho and Chansik An, since these authors contributed equally to this entire work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02581-9) contains supplementary material, which is available to authorized users. * Myeong‑Jin Kim [email protected] 1
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50‑1 Yonsei‑ro, Seodaemun‑gu, Seoul 03722, Korea
King Faisal University College of Medicine, Al Ahsa 31982, Saudi Arabia
2
Hepatocellular carcinoma (HCC) accounts for 80% of primary liver cancer and is a major cause of cancer-related mortality [1]. HCC usually develops in patients with cirrhosis of various etiologies or with chronic hepatitis B [2–5]. In those high-risk patients, current guidelines allow for imaging diagnosis of HCC without histopathologic confirmation if radiologic hallmarks are
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