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Purpose <p>To assess the effectiveness of LI-RADS v2018 and r-LI-RADS in diagnosing subcentimeter hepatocellular carcinoma (HCC) and to evaluate the potential value of serum alpha-fetoprotein (AFP) in conjunction with gadolinium-based contrast-enhanced MRI (CE-MRI) for assessing these lesions.</p> Methods <p>This retrospective study included 179 untreated, high-risk patients with microlesions (&lt; 1&#xa0;cm) from 2015 to 2023. Of these, 92 lesions were pathologically confirmed as HCC, the remaining 87 were non-HCC. Two radiologists independently rated imaging features using LI-RADS and r-LI-RADS. The optimal AFP threshold for HCC diagnosis was determined by the Youden index. Logistic regression analyses identified independent predictors of micro-HCC, leading to the development of new diagnostic criteria.</p> Results <p>Multivariate analysis identified AFP &gt; 12.15 ng/mL, non-peripheral arterial phase enhancement, diffusion restriction, fat deposition, and enhancing capsule as key independent factors for diagnosing micro-HCC. A new criterion requiring at least three positive factors improved sensitivity to 78.3% vs. 58.7% for LR-4 (<i>p</i> = 0.001), with similar specificity (83.9% vs. 81.6%, <i>p</i> = 0.824). It also outperformed r-LR-5/4 and r-LR-4 in sensitivity (78.3% vs. 59.8% and 58.7%, both <i>p</i> = 0.001), without impacting specificity.</p> Conclusion <p>A new criterion (at least three positive findings among AFP &gt; 12.15 ng/mL, non-peripheral arterial phase enhancement, diffusion restriction, fat deposition, and enhancing capsule) significantly improves the diagnostic sensitivity for subcentimeter HCC while maintaining high specificity, demonstrating clear advantages over the LR-4, r-LR-5/4, and r-LR-4 standards of LI-RADS.</p>

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Enhanced diagnostic performance for subcentimeter hepatocellular carcinoma using a novel criterion integrating serum AFP levels and gadolinium-based contrast-enhanced MRI features

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月6日

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  • Xuying Chen,
  • Haoran Dai,
  • Jing Liu,
  • Siyuan Ji,
  • Yuyao Xiao,
  • Xinde Zheng,
  • Kai Hou,
  • Chun Yang

摘要

Purpose

To assess the effectiveness of LI-RADS v2018 and r-LI-RADS in diagnosing subcentimeter hepatocellular carcinoma (HCC) and to evaluate the potential value of serum alpha-fetoprotein (AFP) in conjunction with gadolinium-based contrast-enhanced MRI (CE-MRI) for assessing these lesions.

Methods

This retrospective study included 179 untreated, high-risk patients with microlesions (< 1 cm) from 2015 to 2023. Of these, 92 lesions were pathologically confirmed as HCC, the remaining 87 were non-HCC. Two radiologists independently rated imaging features using LI-RADS and r-LI-RADS. The optimal AFP threshold for HCC diagnosis was determined by the Youden index. Logistic regression analyses identified independent predictors of micro-HCC, leading to the development of new diagnostic criteria.

Results

Multivariate analysis identified AFP > 12.15 ng/mL, non-peripheral arterial phase enhancement, diffusion restriction, fat deposition, and enhancing capsule as key independent factors for diagnosing micro-HCC. A new criterion requiring at least three positive factors improved sensitivity to 78.3% vs. 58.7% for LR-4 (p = 0.001), with similar specificity (83.9% vs. 81.6%, p = 0.824). It also outperformed r-LR-5/4 and r-LR-4 in sensitivity (78.3% vs. 59.8% and 58.7%, both p = 0.001), without impacting specificity.

Conclusion

A new criterion (at least three positive findings among AFP > 12.15 ng/mL, non-peripheral arterial phase enhancement, diffusion restriction, fat deposition, and enhancing capsule) significantly improves the diagnostic sensitivity for subcentimeter HCC while maintaining high specificity, demonstrating clear advantages over the LR-4, r-LR-5/4, and r-LR-4 standards of LI-RADS.