Evaluation of the Consistency of the LI-RADS 2017 as a Non-Invasive Diagnostic Tool for the Detection of Hepatocellular Carcinoma in At-Risk Patients with a Focal Hepatic Lesion
Author(s): Nazanin Sadraei, Rastgooyan Hemmat Allah, Alishavandi Raana, Bijan Bijan, Sadabadi Yoones
Background: Hepatocellular carcinoma (HCC) is the most common type of primary hepatic malignancy. Liver cirrhosis and chronic HBV infection are the most common risk factors for HCC.  Imaging-based HCC diagnosis is considered an acceptable alternative for tissue biopsy in patients with chronic liver disease. Liver Imaging Reporting and Data System (LI-RADS) is a scoring system for reporting and interpreting focal hepatic lesions concerning their subcategories. LR-1 is used for definitely benign lesions, LR-2 for possible benign lesions, LR-3 for equivocal lesions, LR-4 for possible HCC, and LR-5 for definite HCC. LR-TIV is considered a malignant lesion within venous invasion.
Materials and methods: This retrospective study which has been implemented in Namazi university hospital tertiary care, reviews dynamic liver CTs of 29 patients with focal liver lesions and further evaluates the subsequent correlation with the final pathologic diagnosis of HCC. The period is taken from March 2016 to January 2019. The total number of 3000 cases containing pathological reports under HCC diagnosis during the specified 34 months with regards to this study were extracted from the Namazee hospital data center. A liver lesion biopsy was performed on 350 cases. HCC was proved histologically in 100 cases. CT images were available in 45 cases. Eventually, 29 cases were eligible to be evaluated by LI-RADS v2017. However, 16 patients were excluded due to various reasons such as lack of dynamic liver CT-scan protocol, age groups of less than 18, and history of previous intervention on liver lesions. It should be noted that a dynamic liver CT scan with acceptable quality according to LIRADS recommendations was carried out on all the 29 selected cases. Two board-certified radiologists experienced in cross-sectional liver imaging reviewed the case studies and randomly categorized them based on LIRADS v2017. The SPSS22 software was used for statistical analysis, followed by the Chi-square goodness of fit test and T-test. P-values larger than 0.05 were assumed as statistically significant.
Results: 29 patients, in which LIRADS applied to the 17 cases (58.62%) with major risk factors and 12 others with no RF for comparison. Among major imaging features of LI-RADS 2017, 100% of HCC patients showed a washout appearance and all of these lesions were measured above 20mm. Threshold growth could be assessed only in one patient. APHE was confirmed in 93.1%. The least encountered major imaging feature was the presence of enhancing capsule (27%). The most common ancillary features favoring malignancy were discrete nodules on ultrasound (79%),