Cancer Res Treat.  2023 Jul;55(3):939-947. 10.4143/crt.2022.1645.

Intraindividual Comparison of MRIs with Extracellular and Hepatobiliary Contrast Agents for the Noninvasive Diagnosis of Hepatocellular Carcinoma Using the Korean Liver Cancer Association–National Cancer Center 2022 Criteria

• Yoon JK
• Han DH
• Lee S
• Choi JY
• Choi GH
• Kim DY
• Kim MJ

• KMID: 2544174
• DOI: http://doi.org/10.4143/crt.2022.1645

Abstract

Purpose
The aim of the present study was to evaluate the per-lesion sensitivity and specificity of the Korean Liver Cancer Association–National Cancer Center (KLCA-NCC) 2022 criteria for the noninvasive diagnosis of hepatocellular carcinoma (HCC), with intraindividual comparison of the diagnostic performance of magnetic resonance imaging with extracellular agents (ECA-MRI) and hepatobiliary agents (HBA-MRI).
Materials and Methods
Patients at high risk for HCC who were referred to a tertiary academic institution for hepatic lesions with size ≥ 10 mm between July 2019 and June 2022 were enrolled. A total of 91 patients (mean age, 58.1 years; 76 men and 15 women) with 118 lesions who underwent both ECA-MRI and HBA-MRI were eligible for final analysis. The per-lesion sensitivities and specificities of the KLCA-NCC 2022 criteria using ECA-MRI and HBA-MRI were compared using McNemar’s test.
Results
The 118 lesions were 93 HCCs, 4 non-HCC malignancies, and 21 benign lesions. On HBA-MRI, the “definite” HCC category showed significantly higher sensitivity than ECA-MRI (78.5% vs. 58.1%, p < 0.001), with identical specificity (92.0% vs. 92.0%, p > 0.999). For “probable” or “definite” HCC categories, there were no differences in the sensitivity (84.9% vs. 84.9%, p > 0.999) and specificity (84.0% vs. 84.0%, p > 0.999) between ECA-MRI and HBA-MRI.
Conclusion
The “definite” HCC category of the KLCA-NCC 2022 criteria showed higher sensitivity in diagnosing HCC on HBA-MRI compared with ECA-MRI, without compromising specificity. There were no significant differences in the sensitivity and specificity of “probable” or “definite” HCC categories according to ECA-MRI and HBA-MRI.

Keyword

Hepatocellular carcinoma; Magnetic resonance imaging; Gadolinium; Radiology

Figure

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  Fig. 1 Flowchart of the inclusion and exclusion criteria of the study population. ECA-MRI, magnetic resonance imaging with an extracellular agent; HBA-MRI, magnetic resonance imaging with a hepatobiliary agent; HCC, hepatocellular carcinoma.

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  Fig. 2 Categorization of a pathologically confirmed HCC on ECA-MRI and HBA-MRI according to the KLCA-NCC 2022 criteria. A 3.2-cm sized mass in the right posterior section of the liver (arrows) shows moderate T2 hyperintensity and T1 hypointensity. The lesion did not show targetoid appearance on DWI nor enhanced sequences. On ECA-MRI, the mass showed APHE without demonstrable washout appearance during the PVP or DP, and was categorized as “probable” HCC. On HBA-MRI, the mass showed APHE without washout appearance on PVP, but with washout appearance on HBP, and was categorized as “definite” HCC. AP, arterial phase; APHE, arterial phase hyperenhancement; DP, delayed phase; DWI, diffusion-weighted images; ECA-MRI, magnetic resonance imaging with an extracellular agent; HBA-MRI, magnetic resonance imaging with a hepatobiliary agent; HBP, hepatobiliary phase; HCC, hepatocellular carcinoma; KLCA-NCC, Korean Liver Cancer Association-National Cancer Center; PVP, portal venous phase.

Reference

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