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Radiology, Mar 2025, 314 (3) | https://doi.org/10.1148/radiol.241856
LI-RADS for Diagnosing Hepatocellular Carcinoma in Patients with Noncirrhotic Chronic Hepatitis C
Jihyun An*,1, Rohee Park*,2, Euichang Kim3, Seong Kyun Na4,5, Ha Il Kim1, In-Hye Song6,7, Young Seo Cho8, Ji Hun Kang8, Han Chu Lee1,7, Seungbong Han9, Jean-Charles Nault10,11,12, Sang Hyun Choi**,2,7, Ju Hyun Shim**,3,7
1Department of Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Republic of Korea
2Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
3Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
4Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
5Department of Gastroenterology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
6Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
7Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
8Department of Radiology, Hanyang University College of Medicine, Guri, Republic of Korea
9Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
10Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team Functional Genomics of Solid Tumors, Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
11Service d’hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
12Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris nord, Bobigny, France
* J.A. and R.P. contributed equally to this work.
** S.H.C. and J.H.S. are co–senior authors.
Address correspondence to: J.H.S.
1Department of Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Republic of Korea
2Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
3Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
4Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
5Department of Gastroenterology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
6Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
7Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
8Department of Radiology, Hanyang University College of Medicine, Guri, Republic of Korea
9Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
10Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team Functional Genomics of Solid Tumors, Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
11Service d’hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France
12Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris nord, Bobigny, France
* J.A. and R.P. contributed equally to this work.
** S.H.C. and J.H.S. are co–senior authors.
Address correspondence to: J.H.S.
Abstract
Background
The Liver Imaging Reporting and Data System (LI-RADS) criteria have not been validated for patients with noncirrhotic chronic hepatitis C (CHC), who are at a greater risk for hepatocellular carcinoma (HCC) than the general population.
Purpose
To evaluate the diagnostic performance of LI-RADS category 5 (LR-5, indicating definite HCC) observations for HCC using CT and MRI in patients with noncirrhotic CHC and to compare these findings with those in patients with cirrhotic CHC.
Materials and Methods
This retrospective study included patients without cirrhosis with CHC with focal hepatic nodules of 1 cm or greater on dynamic CT or MRI scans who underwent pathologic confirmation at two university hospitals from August 2002 to February 2022. This group served as the test dataset. The primary outcome was the diagnostic performance of LR-5 for HCC using CT and MRI. When LI-RADS categorization differed between CT and MRI, the MRI-based classification was used as the definitive category. Results were validated using a dataset of patients with CHC from two additional hospitals based on the clinical composite reference standard. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated.
Results
The test dataset comprised 458 patients (mean age, 64 years ± 9 [SD]; 350 male; 219 without cirrhosis, 239 with cirrhosis). For noncirrhotic livers, the LR-5 criteria achieved an AUC, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.90 (95% CI: 0.86, 0.93), 85.1% (95% CI: 80.6, 89.7), 82.4% (95% CI: 77.0, 87.8), 97.6% (95% CI: 93.0, 100.0), 99.4% (95% CI: 98.2, 100.0), and 54.7% (95% CI: 43.4, 65.9), respectively. The AUC for LR-5 observations in diagnosing HCC was higher in the noncirrhotic liver group compared with the cirrhotic liver group (AUC, 0.90 [95% CI: 0.86, 0.93] vs 0.79 [95% CI: 0.74, 0.84]; P = .002). The diagnostic performance of the LR-5 criteria for diagnosing HCC was also excellent in patients with noncirrhotic CHC in the validation dataset, which included 155 lesions from 103 patients (mean age, 68 years ± 12; 146 male). The AUC, accuracy, sensitivity, specificity, PPV, and NPV in the validation dataset were 0.91 (95% CI: 0.84, 0.97), 96.1% (95% CI: 93.1, 99.2), 82.9% (95% CI: 70.4, 95.3), 100%, 100%, and 95.2% (95% CI: 91.5, 99.0), respectively.
Conclusion
The diagnostic performance of LR-5 for HCC in patients with noncirrhotic CHC was comparable to that in patients with cirrhosis across various clinical settings.
The Liver Imaging Reporting and Data System (LI-RADS) criteria have not been validated for patients with noncirrhotic chronic hepatitis C (CHC), who are at a greater risk for hepatocellular carcinoma (HCC) than the general population.
Purpose
To evaluate the diagnostic performance of LI-RADS category 5 (LR-5, indicating definite HCC) observations for HCC using CT and MRI in patients with noncirrhotic CHC and to compare these findings with those in patients with cirrhotic CHC.
Materials and Methods
This retrospective study included patients without cirrhosis with CHC with focal hepatic nodules of 1 cm or greater on dynamic CT or MRI scans who underwent pathologic confirmation at two university hospitals from August 2002 to February 2022. This group served as the test dataset. The primary outcome was the diagnostic performance of LR-5 for HCC using CT and MRI. When LI-RADS categorization differed between CT and MRI, the MRI-based classification was used as the definitive category. Results were validated using a dataset of patients with CHC from two additional hospitals based on the clinical composite reference standard. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated.
Results
The test dataset comprised 458 patients (mean age, 64 years ± 9 [SD]; 350 male; 219 without cirrhosis, 239 with cirrhosis). For noncirrhotic livers, the LR-5 criteria achieved an AUC, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.90 (95% CI: 0.86, 0.93), 85.1% (95% CI: 80.6, 89.7), 82.4% (95% CI: 77.0, 87.8), 97.6% (95% CI: 93.0, 100.0), 99.4% (95% CI: 98.2, 100.0), and 54.7% (95% CI: 43.4, 65.9), respectively. The AUC for LR-5 observations in diagnosing HCC was higher in the noncirrhotic liver group compared with the cirrhotic liver group (AUC, 0.90 [95% CI: 0.86, 0.93] vs 0.79 [95% CI: 0.74, 0.84]; P = .002). The diagnostic performance of the LR-5 criteria for diagnosing HCC was also excellent in patients with noncirrhotic CHC in the validation dataset, which included 155 lesions from 103 patients (mean age, 68 years ± 12; 146 male). The AUC, accuracy, sensitivity, specificity, PPV, and NPV in the validation dataset were 0.91 (95% CI: 0.84, 0.97), 96.1% (95% CI: 93.1, 99.2), 82.9% (95% CI: 70.4, 95.3), 100%, 100%, and 95.2% (95% CI: 91.5, 99.0), respectively.
Conclusion
The diagnostic performance of LR-5 for HCC in patients with noncirrhotic CHC was comparable to that in patients with cirrhosis across various clinical settings.
논문정보
- Research article
- 2025년 03월 (BRIC 등록일 2025-03-26)
- 국내(교신)+국외 연구진
- 의약학 > 종양의학
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