Objectives To evaluate the performance of combining serum alpha-fetoprotein (AFP) with LI-RADS (LI-RADS + AFP) on gadoxetate-enhanced MRI for diagnosing hepatocellular carcinoma (HCC) ≤ 3.0 cm and predicting post-surgical patient outcomes, compared to LI-RADS v2018. Methods Patients with hepatic observations ≤ 3.0 cm who underwent preoperative gadoxetate-enhanced MRI and surgical resection were retrospectively analyzed. In LI-RADS + AFP, LR-4 (probably-HCC), LR-M (probably or definitely-malignant but not HCC specific), or LR-TIV (definite-tumor-in-vein) by LI-RADS v2018 was upgraded to LR-5 (definitely-HCC) if they met AFP criteria based on three different cut-offs (≥ 20, ≥ 200, ≥ 400 ng/mL). The sensitivity, specificity, and accuracy of LI-RADS v2018 LR-5 and LI-RADS + AFP LR-5 were compared using generalized estimating equations. Recurrence-free survival (RFS) and overall survival (OS) in the two groups (LR-4/5 vs. LR-M) of LI-RADS v2018 and LI-RADS + AFP were compared using log-rank tests. Results In 520 observations from 414 patients (mean age, 60 ± 9 years; 328 men), LI-RADS + AFP ≥ 20 ng/mL (LI-RADS + AFP20) showed the highest accuracy among the three cut-offs. Compared to LI-RADS v2018, LI-RADS + AFP20 showed significantly higher sensitivity in diagnosing HCC (79.9% [95% confidence interval, 75.7–83.6] vs. 71.8% [67.2–76.1], p < 0.001) and accuracy (82.7% [79.2–85.9] vs. 76.9% [73.1–80.5], p < 0.001) without difference in specificity (93.5% [87.1–97.4] vs. 96.3% [90.8–99.0], p = 0.083). Unlike LI-RADS v2018, showing no difference in RFS between LR-4/5 and LR-M (50.6 vs. 42.6 months; p = 0.078), LI-RADS + AFP20 showed significant differences in RFS (50.6 vs. 35.0 months; p < 0.001) and OS (67.6 vs. 54.8 months, p = 0.008). Conclusion Combining AFP and LI-RADS v2018 resulted in better diagnostic performance and superior post-surgical prognostication compared to LI-RADS v2018 alone. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Serum alpha-fetoprotein (AFP) is a commonly used tumor biomarker for hepatocellular carcinoma (HCC), but there are no studies that applied serum AFP in CT/MRI LI-RADS. <Emphasis Type="BoldItalic">Findings</Emphasis> Combining serum AFP and LI-RADS v2018 had better diagnostic performance for diagnosing HCC ≤ 3.0 cm and superior post-surgical prognostication than LI-RADS v2018 alone. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Integrating serum AFP with LI-RADS v2018 on gadoxetate-enhanced MRI improves the diagnosis and prognostication of HCC patients. These findings provide clinicians with a more robust diagnostic and prognostic framework for managing patients with HCC ≤ 3.0 cm.

Effect of combining serum alpha-fetoprotein with LI-RADS v2018 on gadoxetate-enhanced MRI in the diagnosis and prognostication of hepatocellular carcinoma

期刊论文
发表日期：

2025年2月10日

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Dong Hwan Kim,
Sang Hyun Choi,
Boyeon Koo,
Se Jin Choi,
Hyeon Ji Jang,
Subin Heo,
Jae Ho Byun,
Hyung Jin Won,
Yong Moon Shin

摘要

Objectives

To evaluate the performance of combining serum alpha-fetoprotein (AFP) with LI-RADS (LI-RADS + AFP) on gadoxetate-enhanced MRI for diagnosing hepatocellular carcinoma (HCC) ≤ 3.0 cm and predicting post-surgical patient outcomes, compared to LI-RADS v2018.

Methods

Patients with hepatic observations ≤ 3.0 cm who underwent preoperative gadoxetate-enhanced MRI and surgical resection were retrospectively analyzed. In LI-RADS + AFP, LR-4 (probably-HCC), LR-M (probably or definitely-malignant but not HCC specific), or LR-TIV (definite-tumor-in-vein) by LI-RADS v2018 was upgraded to LR-5 (definitely-HCC) if they met AFP criteria based on three different cut-offs (≥ 20, ≥ 200, ≥ 400 ng/mL). The sensitivity, specificity, and accuracy of LI-RADS v2018 LR-5 and LI-RADS + AFP LR-5 were compared using generalized estimating equations. Recurrence-free survival (RFS) and overall survival (OS) in the two groups (LR-4/5 vs. LR-M) of LI-RADS v2018 and LI-RADS + AFP were compared using log-rank tests.

Results

In 520 observations from 414 patients (mean age, 60 ± 9 years; 328 men), LI-RADS + AFP ≥ 20 ng/mL (LI-RADS + AFP20) showed the highest accuracy among the three cut-offs. Compared to LI-RADS v2018, LI-RADS + AFP20 showed significantly higher sensitivity in diagnosing HCC (79.9% [95% confidence interval, 75.7–83.6] vs. 71.8% [67.2–76.1], p < 0.001) and accuracy (82.7% [79.2–85.9] vs. 76.9% [73.1–80.5], p < 0.001) without difference in specificity (93.5% [87.1–97.4] vs. 96.3% [90.8–99.0], p = 0.083). Unlike LI-RADS v2018, showing no difference in RFS between LR-4/5 and LR-M (50.6 vs. 42.6 months; p = 0.078), LI-RADS + AFP20 showed significant differences in RFS (50.6 vs. 35.0 months; p < 0.001) and OS (67.6 vs. 54.8 months, p = 0.008).

Conclusion

Combining AFP and LI-RADS v2018 resulted in better diagnostic performance and superior post-surgical prognostication compared to LI-RADS v2018 alone.

Key Points

Question Serum alpha-fetoprotein (AFP) is a commonly used tumor biomarker for hepatocellular carcinoma (HCC), but there are no studies that applied serum AFP in CT/MRI LI-RADS.

Findings Combining serum AFP and LI-RADS v2018 had better diagnostic performance for diagnosing HCC ≤ 3.0 cm and superior post-surgical prognostication than LI-RADS v2018 alone.

Clinical relevance Integrating serum AFP with LI-RADS v2018 on gadoxetate-enhanced MRI improves the diagnosis and prognostication of HCC patients. These findings provide clinicians with a more robust diagnostic and prognostic framework for managing patients with HCC ≤ 3.0 cm.