Objective:To investigate the diagnostic efficacy of threshold growth(TG)as a major feature of hepatocellular carcinoma(HCC)in Liver Imaging Reporting and Data System 2018(LI-RADS v2018).Methods:A retrospective analysis of 215 patients with liver cirrhosis was conducted.All patients underwent MRI examinations on initial and follow-up,and had lesions with LI-RADS category 2,3,4 on initial.The frequency of TG and category modifications were recorded.LI-RADS scores were performed when TG was and was not considered a major feature.The association of TG with a diagnosis of HCC was determined by calculating the diagnostic odds ratio(DOR).Taking pathologic or clinical diagnoses as references,with the LI-RADS category 5 as the diagnosis of HCC,the diagnostic efficiency was evaluated with and without the inclusion of TG as a major feature,respectively.Results:There were 253 lesions in 215 patients,including 157 HCC lesions,21 non-HCC malignant lesions and 75 benign lesions.The frequency of TG in HCC was 32.5%(51/157)and TG was significantly associated with HCC with DOR of 5.29(95%CI 2.39～11.75)(P<0.001).When TG was not as a major feature,51 lesions in the HCC group were recategorized as LI-RADS category 3(15 lesions),category 4(6 lesions),category 5(28 lesions)and category M(2 lesions).When TG was as a major feature,15 lesions of LI-RADS category 3 and 6 lesions of category 4 were recategorized as LI-RADS category 5.With LI-RADS category 5 as the diagnosis criteria of HCC,the sensitivity and accuracy of TG as a major feature were significantly higher than those of TG not as a major feature(75.2%vs.61.8%,83.0%vs.75.5%,both P<0.001),the specificity was similar(95.8%vs.97.9%,P=0.683).Conclusions:TG is significantly associated with HCC,the use of TG as a major feature of LI-RADS v2018 can improve the sensitivity and accuracy for diagnosing HCC,especially in HCC with APHE and TG features.
Hepatocellular carcinomaLiver Imaging Reporting and Data SystemThreshold growthFollow-up studies
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