Comparison of the current guidelines for diagnosing hepatocellular carcinoma using gadoxetic acid–enhanced magnetic resonance imaging

Shin Hye Hwang, Mi Suk Park, Sumi Park, Joon Seok Lim, Seung Up Kim, Young Nyun Park

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

Objectives: To compare the performance of current guidelines applicable to the diagnosis of hepatocellular carcinomas (HCCs) using gadoxetic acid–enhanced magnetic resonance imaging (MRI). Methods: Two hundred and forty-one hepatic lesions (149 HCCs, six other malignancies, 86 benign lesions) in 177 patients at risk of HCC without a history of previous treatment for hepatic malignancy in a tertiary center were retrospectively reviewed. Either histopathology results or long-term (> 24 months) follow-up images were used as a standard of reference. All lesions were categorized according to the Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC) guidelines. The sensitivity and specificity thereof were assessed using a generalized estimation equation. Results: For gadoxetic acid–enhanced MRI, LI-RADS (95%, 95% confidence interval [CI] 88–98) and EASL (94%, 95% CI 86–97) yielded the highest specificity, while EASL yielded the lowest sensitivity (54% [95% CI 46–62]). APASL yielded the highest sensitivity (91% [95% CI 86–95]) with the lowest specificity (78% [95% CI 69–86]). KLCSG-NCC showed balanced sensitivity (85% [79–90]) and specificity (88% [95% CI 80–93]). Differences were more prominent in small nodules between 1 and 2 cm. Conclusion: The diagnostic performance of current guidelines for HCC on gadoxetic acid–enhanced MRI was significantly different, and a potential inverse association between sensitivity and specificity was observed. Key Points: • EASL and LI-RADS yielded the highest specificity with the lowest sensitivity, whereas APASL yielded the highest sensitivity with the lowest specificity. • Differences in the diagnostic performances of guidelines were prominent in small nodules between 1 and 2 cm. • Additional evaluation of CT findings improved the diagnostic sensitivity and accuracy of EASL and LI-RADS. Although doing so decreased specificity, it remained above 89–90%.

Original languageEnglish
Pages (from-to)4492-4503
Number of pages12
JournalEuropean Radiology
Volume31
Issue number7
DOIs
Publication statusPublished - 2021 Jul

Bibliographical note

Publisher Copyright:
© 2021, European Society of Radiology.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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