背景肝细胞癌(HCC)的非侵入性诊断指南因全球不同地理区域而异。特别是关于gadoxetic酸增强MRI的标准。目的比较四种不同的国际HCC诊断指南的诊断性能和读者的判断,在HCC高危患者中使用gadoxetic酸增强MRI诊断HCC。材料与方法这项回顾性研究包括未接受治疗的患者,有肝癌的风险,2015年1月至2018年6月在韩国11家三级医院接受了gadoxetic酸增强MRI检查.四位放射科医生根据四项指南独立审查了肝脏局灶性病变(FLL):美国肝病研究协会(AASLD)/肝脏影像报告和数据系统(LI-RADS),韩国肝癌协会-国家癌症中心(KLCA-NCC),欧洲肝脏研究协会(EASL)亚太肝脏研究协会(APASL)。还记录了读者的判断(HCC或非HCC)。病理证实恶性FLL,组织学和临床随访数据用于良性FLL。使用广义估计方程比较了指南的诊断性能。此外,评估了诊断比值比.结果共2445个FLL(中值大小,27.4毫米)在2237例患者中进行了分析(平均年龄,59岁±11[SD];1666例男性患者);69.3%(2445个中的1694个)为HCC。KLCA-NCC显示出最高的准确性(80.0%;95%CI:78.7,81.2;P=.001),在东方指南中具有很高的敏感性(APASL,89.1%[95%CI:87.8,90.3];KLCA-NCC,78.2%[95%CI:76.6,79.7])和西方指南的高特异性(AASLD/LI-RADS,89.6%[95%CI:87.8,91.2];EASL,88.1%[95%CI:86.2,89.9])(P=.001)。AASLD/LI-RADS的诊断比值比为20.7(95%CI:17.0,25.3),KLCA-NCC的18.9(95%CI:15.8,22.6),EASL为16.8(95%CI:13.8,20.4),APASL为8.9(95%CI:7.4,10.7)。读者的判断显示出比指南更高的准确性(准确性,86.0%;95%CI:84.9,86.9;P=.001)。结论在四个不同的国际HCC诊断指南中,东方指南显示出更高的敏感性,而西方指南显示更高的特异性。KLCA-NCC实现了最高的精度,和AASLD/LI-RADS表现出最高的诊断比值比。©RSNA,2024补充材料可用于本文。
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.