Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows
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Vincenza Granata1, Roberta Fusco1, Antonio Avallone2, Francesco Filice1, Fabiana Tatangelo3, Mauro Piccirillo4, Roberto Grassi5, Francesco Izzo4 and Antonella Petrillo1
1Department of Radiology, “Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale”, Naples, Italy
2Department of Abdominal Oncology, “Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale”, Naples, Italy
3Department of Diagnostic Pathology, “Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale”, Naples, Italy
4Department of Abdominal Surgical Oncology, Hepatobiliary Unit, “Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale”, Naples, Italy
5Department of Radiology, Second University of Naples, Piazza Miraglia, Naples, Italy
Roberta Fusco, email: firstname.lastname@example.org
Keywords: HCC, Li-RADS, magnetic resonance imaging, diffusion weighted imaging, dynamic contrast assessment
Received: February 13, 2017 Accepted: March 22, 2017 Published: April 19, 2017
Purpose: To report a critical analysis of major and ancillary MR imaging features in assessment of HCC.
Methods: Retrospectively we evaluated 70 cirrhotic patients with 173 nodules, which were subjected to MR study at 0 time (MR0), after 3 (MR3) and 6 months (MR6) using two different contrast media. EOB-GD-DTPA was injected at MR0 and MR6, while Gd-BT-DO3A at MR3. Three expert hepatic radiologists reviewed all images, recording, according to LI-RADS, the size, the presence and quality of arterial-phase hyperenhancement, washout and capsule appearance, threshold growth. Additionally, we recorded signal intensity (SI) on T2-W images, on DWI, on apparent diffusion coefficient (ADC) maps and SI on T1-W images of EOB-GD-BPTA hepatospecific phase. Median value of ADC and of Intravoxel incoherent motion related parameters were assessed.
Results: 127 HCCs and 24 dysplastic nodules were assessed. Hypervascular on arterial phase was found in 84 HCCs, washout appearance in 124, capsule appearance in 111, hypointensity on hepatospecific phase in 127, hyperintensity on T2-W sequences and restricted diffusion in 107. Hyper vascular on arterial phase was found in 17 dysplastic nodules, wash-out appearance in 2, hypointensity on hepatospecific phase in 7 while no dysplastic nodules showed capsule appearance, hyperintensity on T2-W and restricted diffusion. Highest accuracy was obtained by washout appearance and hypointense signal on hepatospecific phase (97% and 95%).
Conclusions: Hypointensity on hepatospecific phase and washout appearance are the most relevant diagnostic sign for differentiating low-risk from high-risk HCC nodules. The capsule appearance, T2-W hyperintensity and restricted diffusion have high positive predictive value.
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