<p class="first" id="d6353180e143">Purpose To evaluate the performance of major features,
ancillary features, and categories
of Liver Imaging Reporting and Data System (LI-RADS) version 2014 at magnetic resonance
(MR) imaging for the diagnosis of hepatocellular carcinoma (HCC). Materials and Methods
This retrospective institutional review board-approved study included patients with
liver MR imaging and at least one pathologically proved lesion. Between 2004 and 2016,
102 patients (275 observations including 113 HCCs) met inclusion criteria. Two radiologists
independently assessed major and ancillary imaging features for each liver observation
and assigned a LI-RADS category. Per-lesion estimates of diagnostic performance of
major features, ancillary features, and LI-RADS categories were assessed by using
generalized estimating equation models. Results Major features (arterial phase hyperenhancement,
washout, capsule, and threshold growth) had a sensitivity of 88.5%, 60.6%, 32.9%,
and 41.6%, and a specificity of 18.6%, 84.8%, 98.8%, and 83.2% for HCC, respectively.
Ancillary features (mild-moderate T2 hyperintensity, restricted diffusion, mosaic
architecture, intralesional fat, lesional fat sparing, blood products, and subthreshold
growth) had a sensitivity of 62.2%, 54.8%, 9.9%, 30.9%, 23.1%, 2.8%, and 48.3%, and
a specificity of 79.4%, 90.6%, 99.4%, 94.2%, 83.1%, 99.3%, and 91.4% for HCC, respectively.
The LR-5 or LR-5 V categories had a per-lesion sensitivity of 50.8% and a specificity
of 95.8% for HCC, respectively. The LR-4, LR-5, or LR-5 V categories (determined by
using major features only vs combination of major and ancillary features) had a per-lesion
sensitivity of 75.9% and 87.9% and a per-lesion specificity of 87.5% and 86.2%, respectively.
Conclusion The use of ancillary features in combination with major features increases
the sensitivity while preserving a high specificity for the diagnosis of HCC.
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