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Comparison of guidelines for diagnosis of hepatocellular carcinoma using gadoxetic acid–enhanced MRI in transplantation candidates

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare diagnostic performances of current guidelines for the diagnosis of HCC in LT candidates using gadoxetic acid–enhanced liver MRI (Gd-EOB-MRI).

Methods

Eighty-one patients (119 HCCs and 35 non-HCCs) who underwent preoperative Gd-EOB-MRI and subsequent LT were included. Per-lesion imaging diagnoses of HCCs were made using four different guidelines (American Association for the Study of Liver Disease (AASLD), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines, and patient allocation was determined according to Milan criteria (MC). Comparisons of per-lesion sensitivity, specificity, and accuracy of patient allocation between guidelines were performed using logistic regression with generalized estimating equations.

Results

For diagnosis of HCC, AASLD guideline showed highest specificity (97.4%), followed by EASL and KLCA-NCC guidelines (92.1% and 92.1%, p > 0.99 and = 0.15, respectively, in comparison to AASLD), while the specificity of APASL guideline was significantly lower than that of AASLD guideline (78.9% vs. 97.4%, p = 0.006). APASL and KLCA-NCC guidelines (75.9% and 65.6%) showed significantly higher sensitivities than AASLD/EASL guidelines (34.5% and 38.8%, respectively; all ps < 0.001). For organ allocation, KLCA-NCC guideline showed higher accuracy in selecting unsuitable candidates (with non-HCC malignancies or beyond MC HCCs) than EASL guideline (68.4% vs. 31.8%; p = 0.001).

Conclusion

For the diagnosis of HCCs using Gd-EOB-MRI, AASLD guideline provided the highest specificity, followed by EASL, KLCA-NCC, and APASL guidelines with statistically significant difference with only APASL guideline. KLCA-NCC guideline provided the most accurate selection of unsuitable LT candidates.

Key Points

• AASLD/LI-RADS showed the highest specificity, followed by EASL and KLCA-NCC guidelines.

• APASL and KLCA-NCC guidelines allowed more sensitive diagnoses of HCCs.

• KLCA-NCC more accurately classified patients not appropriate transplantation candidates than EASL.

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Abbreviations

AASLD:

American Association for the Study of Liver Disease

APASL:

Asian-Pacific Association for the Study of the Liver

cHCC-CCAs:

Combined hepatocellular and cholangiocarcinomas

EASL:

European Association for the Study of the Liver

GEE:

Generalized estimating equation

HCC:

Hepatocellular carcinoma

KLCA-NCC:

Korean Liver Cancer Association-National Cancer Center

LI-RADS:

Liver Imaging Reporting and Data System

LT:

Liver transplantation

MC:

Milan criteria

MELD:

Model for end-stage liver disease

MRI:

Magnetic resonance imaging

OPTN:

Organ Procurement and Transplantation Network

SD:

Standard deviation

TACE:

Transarterial chemoembolization

UNOS:

United Network for Organ Sharing

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Acknowledgements

The authors thank Chris Woo for his editorial assistance.

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

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea

    Sun Kyung Jeon, Jeong Min Lee, Ijin Joo & Jeongin Yoo

  2. Seoul National University College of Medicine, Seoul, South Korea

    Sun Kyung Jeon, Jeong Min Lee & Ijin Joo

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea

    Jeong Min Lee

  4. Department of Radiology, Inje University Busan Paik Hospital, Busan, South Korea

    Jin-young Park

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Correspondence to Jeong Min Lee.

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Jeon, S.K., Lee, J.M., Joo, I. et al. Comparison of guidelines for diagnosis of hepatocellular carcinoma using gadoxetic acid–enhanced MRI in transplantation candidates. Eur Radiol 30, 4762–4771 (2020). https://doi.org/10.1007/s00330-020-06881-y

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  • DOI: https://doi.org/10.1007/s00330-020-06881-y

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