The utility of diffusion-weighted imaging in improving the sensitivity of LI-RADS classification of small hepatic observations suspected of malignancy

The utility of diffusion-weighted imaging in improving the sensitivity of LI-RADS classification of small hepatic observations suspected of malignancy

Purpose We investigated the added value of diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) in the categorization of small hepatic observation (≤ 20 mm) detected in patients with chronic liver disease in reference to LI-RADS (liver imaging reporting and data system) classificati...

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Published in:Abdominal radiology (New York) Vol. 44; no. 5; pp. 1773 - 1784
Main Authors: Basha, Mohammad Abd Alkhalik, Refaat, Rania, Mohammad, Faten Fawzy, Khamis, Mai E. M., El-Maghraby, Ahmed Mohamed, El Sammak, Ahmed A., Al-Molla, Rania M., Mohamed, Heba A. E., Alnaggar, Ahmad Abdullah, Hassan, Hanan Abdelhameed, Azmy, Taghreed M., Alaa Eldin, Ahmed M., Assy, Mostafa Mohamad, AlAzzazy, Mohamad Zakarya, Altaher, Khaled Mohamed, Tantawy, Heba Fathy, Saber, Sameh, Amin, Mohamed I., Alsowey, Ahmed Mohamed, Radwan, Mohamed Hesham Saleh, Taha, Heba F., Fathy, Talaat, Hanafy, Amr Shaaban, Abdelbary, Eman H.
Format: Journal Article
Language:English
Published: New York Springer US 01-05-2019
Subjects:
COMPUTERIZED TOMOGRAPHY
DIAGNOSIS
Gastroenterology
Hepatobiliary
Hepatology
HEPATOMAS
Imaging
LIVER
Medicine
Medicine & Public Health
NMR IMAGING
PATIENTS
Radiology
RADIOLOGY AND NUCLEAR MEDICINE
STATISTICS
Perfusion MRI
LI-RADS
DWI
Hepatocellular Carcinoma
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Summary:Purpose We investigated the added value of diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) in the categorization of small hepatic observation (≤ 20 mm) detected in patients with chronic liver disease in reference to LI-RADS (liver imaging reporting and data system) classification system. Methods We prospectively evaluated 165 patients with chronic liver disease with small hepatic observations (≤ 20 mm) which were previously categorized as LI-RADS grade 3–5 on dynamic contrast-enhanced CT (DCE-CT). All patients were submitted to a functional MRI including DCE and DWI. Using LI-RADS v2017, two radiologists independently evaluated the observations and assigned a LI-RADS category to each observation using DCE-MRI alone and combined DCE-MRI and DWI/ADC. In the combined technique, the radiologists assigned a LI-RADS category based on a modified LI-RADS criteria in which restricted diffusion on DWI was considered a major feature of HCC. We evaluated the inter-reader agreement with Kappa statistics and compared the diagnostic performance of the LI-RADS with two imaging techniques by Fisher’s exact test using histopathology as the reference standard. Results Combined technique in LI-RADS yielded better sensitivities (reader 1, 97% [65/67]; reader 2, 95.5% [64/67]) for HCC diagnosis than DCE-MRI alone (reader 1, 80.6% [54/67], p  = 0.005; reader 2, 83.6% [56/67], p  = 0.04). The specificities were insignificantly lower in combined technique (reader 1, 88.4% [107/121]; reader 2, 77.7% [94/121]) than in DCE-MRI alone (reader 1, 90.9% [110/121], p  = 0.67; reader 2, 79.3% [96/121], p  = 0.88). The inter-reader agreement of the LI-RADS scores between combined technique and DCE-MRI was good (κ = 0.765). Conclusion The use of DWI/ADC as an additional major criterion, improved the sensitivity of LI-RADS in the diagnosis of HCC while keeping high specificity.
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ISSN:2366-004X
2366-0058
2366-0058
DOI:10.1007/s00261-018-01887-z