Objective We evaluated the value of EC as a major feature for hepatocellular carcinoma (HCC) and its implications on simplifying LI-RADS v2018: by either excluding EC (LI-RADS[EC(−)]), or treating EC as equivalent to other major features (LI-RADS[EC(+)]). Materials and methods This retrospective study included patients who underwent preoperative MRI within 1 month of surgery. Two radiologists independently assigned LI-RADS categories, with consensus resolution. The association between EC and HCC was evaluated by diagnostic odds ratio (DOR). Sensitivity and specificity of LI-RADS[EC(−)] and LI-RADS[EC(+)] were compared to LI-RADS v2018 using generalized estimating equations. Results Among 735 patients (median [interquartile range] age, 60 [54–66] years, 562 men) with 986 observations, 150 (20.4%) underwent extracellular contrast (ECA)-MRI and 585 (79.6%) underwent hepatobiliary contrast (HBA)-MRI. EC was significantly associated with HCC on both ECA-MRI (DOR = 16.6, p < 0.001) and HBA-MRI (DOR = 9.3, p < 0.001). LI-RADS[EC(+)] strategy demonstrated significantly higher sensitivity than LI-RADS v2018 on both ECA-MRI (81.3% vs. 78.4%, p = 0.047) and HBA-MRI (74.2% vs. 72.7%; p = 0.005), without significant differences in specificity (96.7% vs. 96.7%; p > 0.99 for ECA-MRI and 91.7% vs. 92.1%; p = 0.26 for HBA-MRI). However, LI-RADS[EC(−)] yielded a lower sensitivity (74.8% vs. 78.4%; p = 0.03 for ECA-MRI and 72.3% vs. 72.7%; p = 0.17 for HBA-MRI) without a gain in specificity. Conclusion EC is strongly associated with HCC and critical for maintaining the sensitivity of the LI-RADS v2018. Treating EC as equivalent to other major features may simplify LI-RADS and improve sensitivity, particularly on ECA-MRI, where the increase in sensitivity was more pronounced than on HBA-MRI. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Can LIRADS v2018 be simplified by considering enhancing capsule (EC) as equivalent to other major features (i.e., non-peripheral washout), regardless of observation size? <Emphasis Type="BoldItalic">Findings</Emphasis> Treating EC as equivalent to other major features yielded higher sensitivity than LIRADS v2018 on both extracellular- and hepatobiliary contrast-enhanced MRI, without significantly compromising specificity. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> EC is a key feature for hepatocellular carcinoma diagnosis. The strategy of treating EC as equivalent to other major features can be used to increase diagnostic sensitivity as well as simplify LI-RADS v2018, particularly on extracellular contrast-enhanced MRI. Graphical Abstract

Value of enhancing capsule for diagnosing hepatocellular carcinoma on MRI: implications for simplifying LI-RADS

期刊论文
发表日期：

2025年8月22日

查看全文

Se Jin Choi,
Hae Young Kim,
So Jung Lee,
So Yeon Kim,
Hyung Jin Won,
Yong Moon Shin,
Sang Hyun Choi,
Jae Ho Byun

摘要

Objective

We evaluated the value of EC as a major feature for hepatocellular carcinoma (HCC) and its implications on simplifying LI-RADS v2018: by either excluding EC (LI-RADS[EC(−)]), or treating EC as equivalent to other major features (LI-RADS[EC(+)]).

Materials and methods

This retrospective study included patients who underwent preoperative MRI within 1 month of surgery. Two radiologists independently assigned LI-RADS categories, with consensus resolution. The association between EC and HCC was evaluated by diagnostic odds ratio (DOR). Sensitivity and specificity of LI-RADS[EC(−)] and LI-RADS[EC(+)] were compared to LI-RADS v2018 using generalized estimating equations.

Results

Among 735 patients (median [interquartile range] age, 60 [54–66] years, 562 men) with 986 observations, 150 (20.4%) underwent extracellular contrast (ECA)-MRI and 585 (79.6%) underwent hepatobiliary contrast (HBA)-MRI. EC was significantly associated with HCC on both ECA-MRI (DOR = 16.6, p < 0.001) and HBA-MRI (DOR = 9.3, p < 0.001). LI-RADS[EC(+)] strategy demonstrated significantly higher sensitivity than LI-RADS v2018 on both ECA-MRI (81.3% vs. 78.4%, p = 0.047) and HBA-MRI (74.2% vs. 72.7%; p = 0.005), without significant differences in specificity (96.7% vs. 96.7%; p > 0.99 for ECA-MRI and 91.7% vs. 92.1%; p = 0.26 for HBA-MRI). However, LI-RADS[EC(−)] yielded a lower sensitivity (74.8% vs. 78.4%; p = 0.03 for ECA-MRI and 72.3% vs. 72.7%; p = 0.17 for HBA-MRI) without a gain in specificity.

Conclusion

EC is strongly associated with HCC and critical for maintaining the sensitivity of the LI-RADS v2018. Treating EC as equivalent to other major features may simplify LI-RADS and improve sensitivity, particularly on ECA-MRI, where the increase in sensitivity was more pronounced than on HBA-MRI.

Key Points

Question Can LIRADS v2018 be simplified by considering enhancing capsule (EC) as equivalent to other major features (i.e., non-peripheral washout), regardless of observation size?

Findings Treating EC as equivalent to other major features yielded higher sensitivity than LIRADS v2018 on both extracellular- and hepatobiliary contrast-enhanced MRI, without significantly compromising specificity.

Clinical relevance EC is a key feature for hepatocellular carcinoma diagnosis. The strategy of treating EC as equivalent to other major features can be used to increase diagnostic sensitivity as well as simplify LI-RADS v2018, particularly on extracellular contrast-enhanced MRI.

Graphical Abstract