Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features.

Autor: Jiang H; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.; Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA., Song B; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China., Qin Y; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China., Chen J; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China., Xiao D; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA., Ha HI; Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA., Liu X; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China., Oloruntoba-Sanders O; Department of Medicine (Gastroenterology), Duke University Medical Center, Durham, NC, 27710, USA., Erkanli A; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA., Muir AJ; Department of Medicine (Gastroenterology), Duke University Medical Center, Durham, NC, 27710, USA., Bashir MR; Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA. mustafa.bashir@duke.edu.; Department of Medicine (Gastroenterology), Duke University Medical Center, Durham, NC, 27710, USA. mustafa.bashir@duke.edu.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2021 Jun; Vol. 31 (6), pp. 3638-3648. Date of Electronic Publication: 2020 Nov 27.
DOI: 10.1007/s00330-020-07488-z
Abstrakt: Objectives: The LI-RADS M (LR-M) category describes hepatic lesions probably or definitely malignant, but not specific for hepatocellular carcinoma in at-risk patients. Differentiation among LR-M entities, particularly detecting cholangiocarcinoma-containing tumors (M-CCs), is essential for treatment and prognosis. Thus, we aimed to develop diagnostic models on gadoxetate disodium-enhanced MRI comprising serum tumor markers and LI-RADS imaging features for M-CC.
Methods: Consecutive at-risk patients with LR-M lesions exclusively (no co-existing LR-4 and/or LR-5 lesions) were retrieved retrospectively from a prospectively collected database spanning 3 years. Intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (c-HCC-CCA) were classified together as M-CC. LI-RADS features determined by three independent radiologists and clinically relevant serum tumor markers were used to generate M-CC diagnostic models through logistic regression analysis against histology. Per-patient performance was evaluated using area under the receiver operating curve (AUC), sensitivity, and specificity.
Results: Forty-five patients were included, 42.2% (19/45) with hepatocellular carcinoma, 33.3% (15/45) with ICC, 13.3% (6/45) with c-HCC-CCA, and 11.1% (5/45) with other hepatic lesions. Carbohydrate antigen (CA)19-9 > 38 U/mL, α-fetoprotein (AFP) > 4.8 ng/mL, and absence of the LI-RADS feature "blood products in mass" were significant predictors of M-CC. Combining three predictors demonstrated AUC of 0.862, sensitivity of 76%, and specificity of 88%. The risk of M-CC with all three criteria fulfilled was 98% (AUC, 0.690; sensitivity, 38%; specificity, 100%).
Conclusions: In at-risk patients with LR-M lesions, integrating CA19-9, AFP, and the LI-RADS feature "blood products in mass" achieved high diagnostic performance for M-CC. When all three criteria were fulfilled, the specificity for M-CC was 100%.
Key Points: • In at-risk patients who had LR-M lesions exclusively (no concomitant LR-4/5 lesions), a model with carbohydrate antigen > 38 U/mL, α-fetoprotein > 4.8 ng/mL, and absence of the LI-RADS feature "blood products in mass" achieved high accuracy for diagnosing cholangiocarcinoma-containing tumors. • In patients of whom all three criteria were fulfilled, the specificity for M-CC was 100%, which might reduce or eliminate the need for biopsy confirmation.
Databáze: MEDLINE