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Longitudinal evolution of liver imaging reporting and Data system Version 2018 category 2, 3, and 4 observations in cirrhosis on MRI

Fei Xing¹ and Xiance Zhao²
¹the Third People’s Hospital of Nantong, Nantong, China, ²Philips Healthcare, Shanghai, China

Synopsis

The purpose of this study was to evaluate the category modifications and prognosis of LI-RADS 2,2 and 4 observations in cirrhosis on MRI. We retrospectively analyzed 105 LR-2 , 97 LR-3, and 43 LR-4 observations following-up datas. Follow-up duration and category modifications that progressed, remained stable, or decreased were recorded for each observation. Our study showed that LR-2, LR-3 and LR-4 lesions in liver cirrhosis patients present with different natural disease courses and outcomes, the lesions with a higher LI-RADS category have a higher cumulative incidence of progression to LR-5/-TIV lesion, thus demonstrating an increasing risk of developing HCC.

Introduction

Hepatocellular carcinoma (HCC), the most common primary hepatic malignancy worldwide, is a growing health care issue. Cirrhosis is the predominant risk factor for HCC, with 80% of HCC developing in a back-ground of cirrhosis. MRI plays a vital role in the diagnosis and staging of HCC, as early detection and treatment leads to improved outcomes. The Liver Imaging Reporting and Data System (LI-RADS) has been developed to standardize the terminology for reporting, assessing, and recommending action in liver imaging. The main purpose of LI-RADS is to minimize the likelihood of a false diagnosis of definite HCC. LI-RADS stratifies nodules into five categories according to the perceived risk of HCC. LR-1 (definitely benign) observations include cysts and typical hemangiomas. LR-5 (definitely HCC) observations demonstrate arterial phase hyper-enhancement in conjunction with one or more additional major features (washout appearance, capsule appearance, or threshold growth), taking into account the observation diameter. LR-2 (probably benign), LR-3 (intermediate probability for HCC), or LR-4(probably HCC) observations that are thought to have an intermediate and increasing likelihood of HCC^1-4. Although Hong⁵ and Tanabe⁶ et al previously demonstrated that observations categorized as LR-1, LR-2, LR-3, and LR-4 had different imaging outcomes, however those studies were limited by standardized imaging techniques, unable to assess longitudinal clinical outcomes with the recently released LI-RADS v2018, and few LR-2 observations progressed to LR-5^5-12. The purpose of this study was to characterize the MR imaging features and natural outcomes of LR-2, LR-3, and LR-4 nodules, with an emphasis on upgrade to LR-5 or higher by using LI-RADS v2018.

Methods

Data from 158 patients（245 lesions）of cirrhosis who underwent at least one follow-up magnetic resonance imaging (MRI) examination in our institution from May 2012 to September 2018, and were index category as LR-2, LR-3 and LR-4 lesions without biopsy or operation，were retrospectively reviewed. Among all the lesions, 105 were LR-2, 97 were LR-3 and 43 were LR-4. Follow-up duration and category modifications that progressed, remained stable, or decreased were recorded for each observation. The single-factor analysis was used to analyze the follow-up interval of LR-2, LR-3 and LR-4 lesions, and cumulative incidence curves for progression were analyzed using Kaplan-Meier method and Log-rank analysis by SPSS 20.0.

Results

The mean follow-up interval of LR-2, LR-3 and LR-4 was（20.5±11.4）,（18.1±10.5）and（13.8±9.9） months respectively, the difference were statistically significant（F=6.58，P=0.002）. Among 105 index LR-2 lesions, 3 upgraded to LR-5, 2 upgraded to LR-4, 4 upgraded to LR-3, 73 remained stable, and 23 decreased to LR-1. Among 97 index LR-3 lesions, 15 upgraded to LR-5, 6 upgraded to LR-4, 57 remained stable and 18 decreased to LR-1/-2. Among 43 index LR-4 lesions, 15 upgraded to LR-5, among them, 5 demonstrated threshold growth, 7 demonstrated subthreshold growth; 2 progressed to LR-TIV with venous invasion, 23 remained stable and 3 decreased to LR-1. The cumulative incidence of progression to LR-5/-TIV was higher for LR-4 lesions than for LR-3 or LR-2 lesions (each P＜.001). Among them, the cumulative incidence of upgraded to LR-5 in 3, 6, and 12 months, LR-4 lesions were 4.7%、11.6%、31.2%, LR-3 lesions were 0、4.2%、6.6% respectively, and LR-2 lesions were 0. The cumulative incidence of progression to LR≥4 was higher for LR-3 lesions than for LR-2 lesions (P＜.001)

Conclusions

Using LI-RADS on MRI, LR-2, LR-3 and LR-4 lesions in cirrhosis have different natural outcomes, LI-RADS lesions demonstrate increasing risk of progression to HCC with increasing category.

Acknowledgements

NONE

References

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2. American College of Radiology: Liver Imaging Reporting and Data System. https://nrdr.acr.org/lirads/. 2018.

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9. Van der Pol CB, Lim CS, Sirlin CB, et al. Accuracy of the Liver Imaging Reporting and Data System in Computed Tomography and Magnetic Resonance Image Analysis of Hepatocellular Carcinoma or Overall Malignancy-A Systematic Review[J]. Gastroenterology, 2018, 156(4):976-986.

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12. Cannella R, Vernuccio F, Celsa C, et al. Long-term evolution of LI-RADS observations in HCV-related cirrhosis treated with direct-acting antivirals. Liver Int. 2021 Apr 28.

Figures

Fig. 1 Axial MRI obtained in a 56y man with an LR-2 observation that progressed to LR-5 (according to LI-RADS v2018). (a) Observation in hepatic segment 6 shows a homogeneous siderotic nodule (SN), which had uniform low signal on T2WI with a diameter of 12 mm. (b) DWI shows low signal. (c)AP showed no APHE. The observation is categorized as LR-2. Nineteen months later without any interim follow-up exams, the observation has grown to 17 mm, (d, e)observation shows hypointensity on T2WI and DWI. (f) AP shows hyperenhancement, and (g) DP shows washout. The observation now is categorized as LR-5

Fig. 2 Axial MR images obtained in a 64-year-old woman with an LR-3 observation that progressed to LR-5 (according to LI-RADS v2018). (a)Observation in hepatic segment 8 shows APHE with a diameter of 7 mm. (b) DP shows no washout. The observation is categorized as LR-3. Thirteen months later without any interim follow-up exams, the observation has grown to 14 mm, (c)observation shows APHE, and (d) DP shows washout. The observation now is categorized as LR-5

Fig. 3 Axial MR images obtained in a 48-year-old man with an LR-4 observation that progressed to LR-5 (according to LI-RADS v2018). (a)Observation in hepatic segment 8 shows APHE with a diameter of 19 mm. (b) DP shows no washout. The observation is categorized as LR-4. Six months later without any interim follow-up exams, the observation has grown to 32 mm, (c)observation shows APHE, and (d) DP shows no washout. The observation now is categorized as LR-5

Fig. 4 Graph shows the cumulative incidence of progression to a malignant category (LR-5 or LR-TIV) for index LR-2, LR-3, and LR-4 observations (according to LI-RADS v 2018). Curves show the cumulative incidence of progression to a malignant category (LR-5 or LR-TIV) of observations categorized as LR-2, LR-3, or LR-4 at baseline.

Graph shows the cumulative incidence of progression to LR-4 or higher for index LR-2, LR-3 observations (according to LI-RADS v 2018).

Proc. Intl. Soc. Mag. Reson. Med. 30 (2022)

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DOI: https://doi.org/10.58530/2022/4194