간경변증이 없는 만성 C 형 간염 환자의 간세포암종 진단을 위한 LI-RADS 기준의 정확성에 관한 연구

Abstract

Background and aims: Despite the known risk of HCC beyond chance, the LI-RADS criteria have not been validated for noncirrhotic patients with chronic hepatitis C (CHC). We aimed to evaluate the diagnostic performance of LR-5 observations for HCC in these patients, in comparison to their cirrhotic counterparts. Methods: We analyzed 22 years of consecutive data from CHC patients who had focal hepatic nodules ≥1 cm on dynamic CT or MRI scans and who subsequently underwent pathologic confirmation through biopsy or resection at three university hospitals. All images were reviewed by two radiologists using the LI-RADS classification. Results: Our study included 529 lesions from 474 patients: 239 from 223 noncirrhotic patients and 290 from 251 cirrhotic patients. The pathologies consisted of 448 HCCs, 54 other malignant masses, and 27 benign lesions. Non-HCC lesions among LR-5 observations were identified in one noncirrhotic and three cirrhotic cases. For lesions from noncirrhotic livers, the LR-5 criteria for diagnosing HCC demonstrated a sensitivity, specificity, PPV, and NPV of 82.1% (95% CI, 76.7-87.4), 97.7% (93.3-100.0), 99.4% (98.2-100.0), and 55.1% (44.1-66.2), respectively. The specificity and PPV were comparable to those of cirrhotic counterparts. Stratified analyses of noncirrhotics showed that viral and imaging factors did not affect LR-5 efficacies. Fagan’s nomogram indicated that the HCC probability for LR-5 nodules exceeded 95% even in noncirrhotic patients with a low-risk aMAP score of 40, equivalent to a pre-test prevalence of 40%. Conclusions: Given the impressive performance of the LR-5 criteria in this multicenter study, imaging alone may suffice for diagnosing HCC in noncirrhotic CHC patients, even if not at aMAP high-risk.