Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors

Tyler J. Fraum; Roberto Cannella; Daniel R. Ludwig; Richard Tsai; Muhammad Naeem; Maverick LeBlanc; Amber Salter; Allan Tsung; Anup S. Shetty; Amir A. Borhani; Alessandro Furlan; Kathryn J. Fowler

doi:10.1007/s00330-019-06448-6

Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors

Tyler J. Fraum^*, Roberto Cannella, Daniel R. Ludwig, Richard Tsai, Muhammad Naeem, Maverick LeBlanc, Amber Salter, Allan Tsung, Anup S. Shetty, Amir A. Borhani, Alessandro Furlan, Kathryn J. Fowler

^*Corresponding author for this work

Radiology

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Objectives: To determine whether the LI-RADS imaging features of primary liver carcinomas (PLCs) other than hepatocellular carcinoma (non-HCC PLCs) differ between patients considered high risk (RF+) versus not high risk (RF−) for HCC and to compare rates of miscategorization as probable or definite HCC between the RF+ and RF− populations. Methods: This retrospective study included all pathology-proven non-HCC PLCs imaged with liver-protocol CT or MRI from 2007 to 2017 at two liver transplant centers. Patients were defined per LI-RADS v2018 criteria as RF+ or RF−. Two independent, blinded readers (R1, R2) categorized 265 lesions using LI-RADS v2018. Logistic regression was utilized to assess for differences in imaging feature frequencies between RF+ and RF− patients. Fisher’s exact test was used to assess for differences in miscategorization rates. Results: Non-HCC PLCs were significantly more likely to exhibit nonrim arterial phase hyperenhancement (R1: OR = 2.94; R2: OR = 7.09) and nonperipheral “washout” (R1: OR = 3.65; R2: OR = 7.69) but significantly less likely to exhibit peripheral “washout” (R1: OR = 0.30; R2: OR = 0.10) and delayed central enhancement (R1: OR = 0.18; R2: OR = 0.25) in RF+ patients relative to RF− patients. Consequently, non-HCC PLCs were more often miscategorized as probable or definite HCC in RF+ versus RF− patients (R1: 23.3% vs. 3.6%, p < 0.001; R2: 11.0% vs. 2.6%, p = 0.009). Conclusions: Non-HCC PLCs are more likely to mimic HCCs on CT and MRI in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors. Key Points: • The presence of LI-RADS-defined risk factors for HCC tends to alter the imaging appearances of non-HCC PLCs, resulting in higher frequencies of major features and lower frequencies of LR-M features. • Non-HCC PLCs are more likely to be miscategorized as probable or definite HCC in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors.

Original language	English (US)
Pages (from-to)	996-1007
Number of pages	12
Journal	European Radiology
Volume	30
Issue number	2
DOIs	https://doi.org/10.1007/s00330-019-06448-6
State	Published - Feb 1 2020

Funding

The authors state that this work has not received any funding. Dr. Ludwig receives salary support from the Training OPportunities in Translational Imaging Education and Research (TOP-TIER) Holden Thorp grant at Washington University.

Keywords

Bile duct neoplasms
Carcinoma, hepatocellular
Cholangiocarcinoma
Liver cirrhosis
Liver neoplasms

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00330-019-06448-6

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Fraum, T. J., Cannella, R., Ludwig, D. R., Tsai, R., Naeem, M., LeBlanc, M., Salter, A., Tsung, A., Shetty, A. S., Borhani, A. A., Furlan, A., & Fowler, K. J. (2020). Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors. European Radiology, 30(2), 996-1007. https://doi.org/10.1007/s00330-019-06448-6

@article{2eb24cc34a7141cc8e266d5bc416ad2d,

title = "Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors",

abstract = "Objectives: To determine whether the LI-RADS imaging features of primary liver carcinomas (PLCs) other than hepatocellular carcinoma (non-HCC PLCs) differ between patients considered high risk (RF+) versus not high risk (RF−) for HCC and to compare rates of miscategorization as probable or definite HCC between the RF+ and RF− populations. Methods: This retrospective study included all pathology-proven non-HCC PLCs imaged with liver-protocol CT or MRI from 2007 to 2017 at two liver transplant centers. Patients were defined per LI-RADS v2018 criteria as RF+ or RF−. Two independent, blinded readers (R1, R2) categorized 265 lesions using LI-RADS v2018. Logistic regression was utilized to assess for differences in imaging feature frequencies between RF+ and RF− patients. Fisher{\textquoteright}s exact test was used to assess for differences in miscategorization rates. Results: Non-HCC PLCs were significantly more likely to exhibit nonrim arterial phase hyperenhancement (R1: OR = 2.94; R2: OR = 7.09) and nonperipheral “washout” (R1: OR = 3.65; R2: OR = 7.69) but significantly less likely to exhibit peripheral “washout” (R1: OR = 0.30; R2: OR = 0.10) and delayed central enhancement (R1: OR = 0.18; R2: OR = 0.25) in RF+ patients relative to RF− patients. Consequently, non-HCC PLCs were more often miscategorized as probable or definite HCC in RF+ versus RF− patients (R1: 23.3% vs. 3.6%, p < 0.001; R2: 11.0% vs. 2.6%, p = 0.009). Conclusions: Non-HCC PLCs are more likely to mimic HCCs on CT and MRI in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors. Key Points: • The presence of LI-RADS-defined risk factors for HCC tends to alter the imaging appearances of non-HCC PLCs, resulting in higher frequencies of major features and lower frequencies of LR-M features. • Non-HCC PLCs are more likely to be miscategorized as probable or definite HCC in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors.",

keywords = "Bile duct neoplasms, Carcinoma, hepatocellular, Cholangiocarcinoma, Liver cirrhosis, Liver neoplasms",

author = "Fraum, {Tyler J.} and Roberto Cannella and Ludwig, {Daniel R.} and Richard Tsai and Muhammad Naeem and Maverick LeBlanc and Amber Salter and Allan Tsung and Shetty, {Anup S.} and Borhani, {Amir A.} and Alessandro Furlan and Fowler, {Kathryn J.}",

note = "Funding Information: The authors state that this work has not received any funding. Dr. Ludwig receives salary support from the Training OPportunities in Translational Imaging Education and Research (TOP-TIER) Holden Thorp grant at Washington University. Publisher Copyright: {\textcopyright} 2019, European Society of Radiology.",

year = "2020",

month = feb,

day = "1",

doi = "10.1007/s00330-019-06448-6",

language = "English (US)",

volume = "30",

pages = "996--1007",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "2",

}

Fraum, TJ, Cannella, R, Ludwig, DR, Tsai, R, Naeem, M, LeBlanc, M, Salter, A, Tsung, A, Shetty, AS, Borhani, AA, Furlan, A & Fowler, KJ 2020, 'Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors', European Radiology, vol. 30, no. 2, pp. 996-1007. https://doi.org/10.1007/s00330-019-06448-6

Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors. / Fraum, Tyler J.; Cannella, Roberto; Ludwig, Daniel R. et al.
In: European Radiology, Vol. 30, No. 2, 01.02.2020, p. 996-1007.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018

T2 - comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors

AU - Fraum, Tyler J.

AU - Cannella, Roberto

AU - Ludwig, Daniel R.

AU - Tsai, Richard

AU - Naeem, Muhammad

AU - LeBlanc, Maverick

AU - Salter, Amber

AU - Tsung, Allan

AU - Shetty, Anup S.

AU - Borhani, Amir A.

AU - Furlan, Alessandro

AU - Fowler, Kathryn J.

N1 - Funding Information: The authors state that this work has not received any funding. Dr. Ludwig receives salary support from the Training OPportunities in Translational Imaging Education and Research (TOP-TIER) Holden Thorp grant at Washington University. Publisher Copyright: © 2019, European Society of Radiology.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Objectives: To determine whether the LI-RADS imaging features of primary liver carcinomas (PLCs) other than hepatocellular carcinoma (non-HCC PLCs) differ between patients considered high risk (RF+) versus not high risk (RF−) for HCC and to compare rates of miscategorization as probable or definite HCC between the RF+ and RF− populations. Methods: This retrospective study included all pathology-proven non-HCC PLCs imaged with liver-protocol CT or MRI from 2007 to 2017 at two liver transplant centers. Patients were defined per LI-RADS v2018 criteria as RF+ or RF−. Two independent, blinded readers (R1, R2) categorized 265 lesions using LI-RADS v2018. Logistic regression was utilized to assess for differences in imaging feature frequencies between RF+ and RF− patients. Fisher’s exact test was used to assess for differences in miscategorization rates. Results: Non-HCC PLCs were significantly more likely to exhibit nonrim arterial phase hyperenhancement (R1: OR = 2.94; R2: OR = 7.09) and nonperipheral “washout” (R1: OR = 3.65; R2: OR = 7.69) but significantly less likely to exhibit peripheral “washout” (R1: OR = 0.30; R2: OR = 0.10) and delayed central enhancement (R1: OR = 0.18; R2: OR = 0.25) in RF+ patients relative to RF− patients. Consequently, non-HCC PLCs were more often miscategorized as probable or definite HCC in RF+ versus RF− patients (R1: 23.3% vs. 3.6%, p < 0.001; R2: 11.0% vs. 2.6%, p = 0.009). Conclusions: Non-HCC PLCs are more likely to mimic HCCs on CT and MRI in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors. Key Points: • The presence of LI-RADS-defined risk factors for HCC tends to alter the imaging appearances of non-HCC PLCs, resulting in higher frequencies of major features and lower frequencies of LR-M features. • Non-HCC PLCs are more likely to be miscategorized as probable or definite HCC in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors.

AB - Objectives: To determine whether the LI-RADS imaging features of primary liver carcinomas (PLCs) other than hepatocellular carcinoma (non-HCC PLCs) differ between patients considered high risk (RF+) versus not high risk (RF−) for HCC and to compare rates of miscategorization as probable or definite HCC between the RF+ and RF− populations. Methods: This retrospective study included all pathology-proven non-HCC PLCs imaged with liver-protocol CT or MRI from 2007 to 2017 at two liver transplant centers. Patients were defined per LI-RADS v2018 criteria as RF+ or RF−. Two independent, blinded readers (R1, R2) categorized 265 lesions using LI-RADS v2018. Logistic regression was utilized to assess for differences in imaging feature frequencies between RF+ and RF− patients. Fisher’s exact test was used to assess for differences in miscategorization rates. Results: Non-HCC PLCs were significantly more likely to exhibit nonrim arterial phase hyperenhancement (R1: OR = 2.94; R2: OR = 7.09) and nonperipheral “washout” (R1: OR = 3.65; R2: OR = 7.69) but significantly less likely to exhibit peripheral “washout” (R1: OR = 0.30; R2: OR = 0.10) and delayed central enhancement (R1: OR = 0.18; R2: OR = 0.25) in RF+ patients relative to RF− patients. Consequently, non-HCC PLCs were more often miscategorized as probable or definite HCC in RF+ versus RF− patients (R1: 23.3% vs. 3.6%, p < 0.001; R2: 11.0% vs. 2.6%, p = 0.009). Conclusions: Non-HCC PLCs are more likely to mimic HCCs on CT and MRI in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors. Key Points: • The presence of LI-RADS-defined risk factors for HCC tends to alter the imaging appearances of non-HCC PLCs, resulting in higher frequencies of major features and lower frequencies of LR-M features. • Non-HCC PLCs are more likely to be miscategorized as probable or definite HCC in the LI-RADS target population than in patients without LI-RADS-defined HCC risk factors.

KW - Bile duct neoplasms

KW - Carcinoma, hepatocellular

KW - Cholangiocarcinoma

KW - Liver cirrhosis

KW - Liver neoplasms

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DO - 10.1007/s00330-019-06448-6

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AN - SCOPUS:85074610491

SN - 0938-7994

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JO - European Radiology

JF - European Radiology

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ER -

Assessment of primary liver carcinomas other than hepatocellular carcinoma (HCC) with LI-RADS v2018: comparison of the LI-RADS target population to patients without LI-RADS-defined HCC risk factors

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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