Targetoid appearance on T2-weighted imaging and signs of tumor vascular involvement: diagnostic value for differentiating HCC from other primary liver carcinomas (original) (raw)

Abstract

Objectives

To evaluate targetoid appearance on T2-weighted imaging and signs of tumor vascular involvement as potential new LI-RADS features for differentiating hepatocellular carcinoma (HCC) from other non-HCC primary liver carcinomas (PLCs).

Methods

This IRB-approved, retrospective study was performed at two liver transplant centers. The final population included 375 patients with pathologically proven lesions imaged between 2007 and 2017 with contrast-enhanced CT or MRI. The cohort consisted of 165 intrahepatic cholangiocarcinomas and 74 combined hepatocellular-cholangiocarcinomas, with the addition of 136 HCCs for control. Two abdominal radiologists (R1; R2) independently reviewed the imaging studies (112 CT; 263 MRI) and recorded the presence of targetoid appearance on T2-weighted images and features of tumor vascular involvement including encasement, narrowing, tethering, occlusion, and obliteration. The sensitivity and specificity of each feature were calculated for the diagnosis of non-HCC PLCs. Cohen’s kappa (k) test was used to assess inter-reader agreement.

Results

The sensitivity of targetoid appearance on T2-weighted images for the diagnosis of non-HCC PLCs was 27.5% and 32.6% (R1 and R2) and the specificity was 98.2% and 97.3% (R1 and R2). Among the features of tumor vascular involvement, those providing the highest sensitivity for non-HCC PLCs were vascular encasement (R1: 34.3%; R2: 37.2%) and obliteration (R1: 25.5%; R2: 29.7%). The highest specificity for non-HCC PLCs was provided by tethering (R1: 100%; R2: 97.1%) and occlusion (R1: 99.3%; R2: 99.3%). The inter-reader agreement was moderate to substantial (k = 0.48–0.77).

Conclusions

Targetoid appearance on T2-weighted images and features of tumor vascular involvement demonstrated high specificity for non-HCC malignancy.

Key Points

• Targetoid appearance on T2-weighted imaging and signs of tumor vascular involvement have high specificity (92–100%) for the diagnosis of non-HCC PLCs, regardless of the presence of liver risk factors.

• In the subset of patients with risk factors for HCC, the sensitivity of signs of tumor vascular involvement decreases for both readers (1.7–20.3%), while the specificity increases reaching values higher than 94.2%.

• The inter-reader agreement is substantial for targetoid appearance on T2-weighted images (k = 0.74) and moderate to substantial for signs of tumor vascular involvement (k = 0.48–0.77).

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Abbreviations

cHCC-CCA:

Combined hepatocellular-cholangiocarcinoma

CI:

Confidence interval

HCC:

Hepatocellular carcinoma

HVs:

Hepatic veins

iCCA:

Intrahepatic cholangiocarcinoma

IVC:

Inferior vena cava

LI-RADS:

Liver Imaging Reporting and Data System

PLCs:

Primary liver carcinomas

PV:

Portal vein

TIV:

Tumor in vein

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Section of Radiology - BiND, University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127, Palermo, Italy
    Roberto Cannella
  2. Department of Radiology, Abdominal Imaging Division, University of Pittsburgh, 200 Lothrop St, UPMC Presbyterian Suite 200, Pittsburgh, PA, 15213, USA
    Roberto Cannella, Amir A. Borhani & Alessandro Furlan
  3. Mallinckrodt Institute of Radiology Washington University School of Medicine, 216 S Kingshighway Blvd, Saint Louis, MO, 63110, USA
    Tyler J. Fraum & Daniel R. Ludwig
  4. Department of Radiology, Division of Abdominal Imaging, Northwestern University Feinberg School of medicine, 676 N St.Clair St., Chicago, IL, 60611, USA
    Amir A. Borhani
  5. Department of Surgery, The Ohio State University Medical Center, N924 Doan Hall, 410 W 10h Ave, Columbus, OH, 43210, USA
    Allan Tsung
  6. Department of Radiology, University of California San Diego, 200 W Arbor Dr., San Diego, CA, 92103, USA
    Kathryn J. Fowler

Authors

  1. Roberto Cannella
  2. Tyler J. Fraum
  3. Daniel R. Ludwig
  4. Amir A. Borhani
  5. Allan Tsung
  6. Alessandro Furlan
  7. Kathryn J. Fowler

Corresponding author

Correspondence toRoberto Cannella.

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Guarantor

The scientific guarantor of this publication is Alessandro Furlan.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Tyler J. Fraum: consultant for Arterys; research support from Siemens.

Amir A. Borhani: consultant for Guebert; book contract from Elsevier/Amirsys.

Alessandro Furlan: consultant for Bracco; royalties from Elsevier.

Statistics and biometry

One of the authors (Tyler J. Fraum) has significant statistical expertise.

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

We would like to specify that, given to the 10-year inclusion period, eligible patients selected for this study in both participating Institutions were also included in prior studies (Title 1: Hepatocellular carcinoma (HCC) versus non-HCC: accuracy and reliability of Liver Imaging Reporting and Data System v2018 [n = 178] – Title 2: Expanding the Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic population: performance and reliability of LI-RADS for distinguishing hepatocellular carcinoma (HCC) from non-HCC primary liver carcinoma in patients who do not meet strict LI-RADS high-risk criteria [n = 131] – Title 3: Assessment of Primary Liver Carcinomas other than Hepatocellular Carcinoma (HCC) with LI-RADS v2018: Comparison of the LI-RADS Target Population to Patients without LI-RADS-defined HCC Risk Factors [n = 265]) not related to this investigation. However, for this study, all the patients were re-reviewed in a blinded fashion by authors not involved in prior imaging assessment.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Cannella, R., Fraum, T.J., Ludwig, D.R. et al. Targetoid appearance on T2-weighted imaging and signs of tumor vascular involvement: diagnostic value for differentiating HCC from other primary liver carcinomas.Eur Radiol 31, 6868–6878 (2021). https://doi.org/10.1007/s00330-021-07743-x

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