J Liver Cancer.  2024 Sep;24(2):206-216. 10.17998/jlc.2024.05.01.

Re-assessing the diagnostic value of the enhancing capsule in hepatocellular carcinoma imaging

• Bae JS
• Lee JM
• Hur BY
• Yoo J
• Park SJ

• KMID: 2559467
• DOI: http://doi.org/10.17998/jlc.2024.05.01

Abstract

Backgrounds/Aims
The enhancing capsule (EC) in hepatocellular carcinoma (HCC) diagnosis has received varying degrees of recognition across major guidelines. This study aimed to assess the diagnostic utility of EC in HCC detection.
Methods
We retrospectively analyzed patients who underwent pre-surgical computed tomography (CT) and hepatobiliary agent-enhanced magnetic resonance imaging (HBA-MRI) between January 2016 and December 2019. A single hepatic tumor was confirmed based on the pathology of each patient. Three radiologists independently reviewed the images according to the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria and reached a consensus. Interobserver agreement for EC before reaching a consensus was quantified using Fleiss κ statistics. The impact of EC on the LI-RADS classification was assessed by comparing the positive predictive values for HCC detection in the presence and absence of EC.
Results
In total, 237 patients (median age, 60 years; 184 men) with 237 observations were included. The interobserver agreement for EC detection was notably low for CT (κ=0.169) and HBA-MRI (κ=0.138). The presence of EC did not significantly alter the positive predictive value for HCC detection in LI-RADS category 5 observations on CT (94.1% [80/85] vs. 94.6% [88/93], P=0.886) or HBAMRI (95.7% [88/92] vs. 90.6% [77/85], P=0.178).
Conclusions
The diagnostic value of EC in HCC diagnosis remains questionable, given its poor interobserver agreement and negligible impact on positive predictive values for HCC detection. This study challenges the emphasis on EC in certain diagnostic guidelines and suggests the need to re-evaluate its role in HCC imaging.

Keyword

Liver neoplasms; Carcinoma, hepatocellular; Radiology

Figure

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  Figure 1. Study flow diagram. LI-RADS, Liver Imaging Reporting and Data System; CT, computed tomography; HBA-MRI, hepatobiliary agent-enhanced magnetic resonance imaging; LR-TIV, LI-RADS tumor in vein; LR-M, LI-RADS M.

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  Figure 2. Representative examples of enhancing capsule. In a 54-year-old woman, compared to the arterial phase image (A), an enhancing capsule (arrowheads) is noted on the portal venous phase CT axial image (B). In a 79-year-old man, compared to the arterial phase image (C), an enhancing capsule (arrowheads) is noted on the portal venous phase MRI axial image (D). CT, computed tomography; MRI, magnetic resonance imaging.

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Reference

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