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    Home > Active Ingredient News > Antitumor Therapy > Eur Radiol: The latest version of LI-RADS arterial phase subtraction imaging-is arterial phase subtraction imaging only suitable for high signal lesions?

    Eur Radiol: The latest version of LI-RADS arterial phase subtraction imaging-is arterial phase subtraction imaging only suitable for high signal lesions?

    • Last Update: 2021-04-17
    • Source: Internet
    • Author: User
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    The Liver Imaging Report and Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technology, interpretation, report and data collection of liver imaging in high-risk patients with hepatocellular carcinoma (HCC).
    However, although LI-RADS provides a highly specific non-invasive
    diagnostic method for the diagnosis of HCC (LR-5 classification) , its sensitivity is less than optimal.
    Non-circular arterial hyperenhancement (APHE) is a necessary condition for the diagnosis of LR-5 classification.
    Without non-circular APHE, it cannot be classified into LR-5 classification.


    The Liver Imaging Report and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging of high-risk patients with hepatocellular carcinoma (HCC) in terms, techniques, interpretation, reports and data collection.
    However, although LI-RADS provides a highly specific non-invasive
    diagnostic method for the diagnosis of HCC (LR-5 classification) , its sensitivity is less than optimal.
    Non-circular arterial hyperenhancement (APHE) is a necessary condition for the diagnosis of LR-5 classification.
    Without non-circular APHE, it cannot be classified into LR-5 classification.
    diagnosis


    In recent years, the development of MRI co-registration technology has made it possible to acquire subtraction imaging, which is defined as a post-processing image generated by subtracting a plain image from an enhanced T1-weighted image.
    In clinical practice, arterial phase (AP) subtraction imaging is increasingly used to detect and characterize APHE.
    According to previous reports, compared with AP images or plain scan and AP images, subtractive AP imaging has a higher detection rate for APHE and better diagnostic performance for HCC.
    However, according to the regulations of the LI-RADS 2018 CT/MRI manual, subtraction images can only be used to observe lesions with essentially T1 signal intensity, and should not be used to observe lesions with low or equal signal intensity on the T1-weighted image before enhancement.
    However, at this stage, there is not enough evidence to support the use of subtraction imaging for the diagnosis and characterization of T1 high, equal, and low signal intensity lesions.


    In recent years, the development of MRI co-registration technology has made it possible to acquire subtraction imaging, which is defined as a post-processing image generated by subtracting a plain image from an enhanced T1-weighted image.
    In clinical practice, arterial phase (AP) subtraction imaging is increasingly used to detect and characterize APHE.
    According to previous reports, compared with AP images or plain scan and AP images, subtractive AP imaging has a higher detection rate for APHE and better diagnostic performance for HCC.
    However, according to the regulations of the LI-RADS 2018 CT/MRI manual, subtraction images can only be used to observe lesions with essentially T1 signal intensity, and should not be used to observe lesions with low or equal signal intensity on the T1-weighted image before enhancement.
    However, at this stage, there is not enough evidence to support the use of subtraction imaging for the diagnosis and characterization of T1 high, equal, and low signal intensity lesions.


    Recently, a study published in the journal European Radiology compares AP (arterial phase) subtraction imaging applied only to T1 high-intensity lesions with the application of T1 high, equal, and low signal based on the enhanced MRI of gadoxetate disodium.
    The diagnostic performance of lesion subtraction AP imaging for HCC detection has expanded the diagnostic scope of Gadoxetate disodium enhanced MRI in the diagnosis of HCC on T1 low or isosignal lesions.


    Recently, a study published in the journal European Radiology compares AP (arterial phase) subtraction imaging applied only to T1 high-intensity lesions with the application of T1 high, equal, and low signal based on the enhanced MRI of gadoxetate disodium.
    The diagnostic performance of lesion subtraction AP imaging for HCC detection has expanded the diagnostic scope of Gadoxetate disodium enhanced MRI in the diagnosis of HCC on T1 low or isosignal lesions.


    This study retrospectively included 234 high-risk HCC patients (311 lesions, including 239 HCC) who underwent gadoxetate disodium-enhanced MRI subtraction AP imaging from 2015 to 2017.
    Arterial phase hyper-enhancement (APHE) is divided into two subtypes: conventional APHE, which only uses subtracted AP imaging to detect T1 high signal lesions; modified APHE, subtracted AP imaging is used for T1 high, equal and low signal lesions .
    Two readers independently reviewed all observations and compared the diagnostic performance of each observation using the McNemar test.


    This study retrospectively included 234 high-risk HCC patients (311 lesions, including 239 HCC) who underwent gadoxetate disodium-enhanced MRI subtraction AP imaging from 2015 to 2017.
    Arterial phase hyper-enhancement (APHE) is divided into two subtypes: conventional APHE, which only uses subtracted AP imaging to detect T1 high signal lesions; modified APHE, subtracted AP imaging is used for T1 high, equal and low signal lesions .
    Two readers independently reviewed all observations and compared the diagnostic performance of each observation using the McNemar test.

    Table 1 The diagnostic performance of conventional and modified non-circular APHE in diagnosing HCC with the same data.
    The sensitivity of modified non-circular APHE was significantly higher than that of conventional non-circular APHE (90.
    0% vs 82.
    8%; p <0.
    001), and there was no significant difference in specificity (66.
    7% vs 68.
    1%; p> 0.
    999).

    Table 1 The diagnostic performance of conventional and modified non-circular APHE in diagnosing HCC with the same data.
    The sensitivity of modified non-circular APHE was significantly higher than that of conventional non-circular APHE (90.
    0% vs 82.
    8%; p <0.
    001), and there was no significant difference in specificity (66.
    7% vs 68.
    1%; p> 0.
    999).

    Table 2 The diagnostic performance of the LR-5 classification using conventional and modified non-circular APHE in diagnosing HCC with the same data.
    The modified non-circular APHE of the LR-5 classification showed higher sensitivity than the conventional non-circular APHE of the LR-5 classification (70.
    3% vs 63.
    2%; p <0.
    001), and the specificity was not significantly reduced (94.
    4% vs 95.
    8%; p > 0.
    999).

    Table 2 The diagnostic performance of the LR-5 classification using conventional and modified non-circular APHE in diagnosing HCC with the same data.
    The modified non-circular APHE of the LR-5 classification showed higher sensitivity than the conventional non-circular APHE of the LR-5 classification (70.
    3% vs 63.
    2%; p <0.
    001), and the specificity was not significantly reduced (94.
    4% vs 95.
    8%; p > 0.
    999).


    This study expanded the 2018 version of LI-RADS gadoxetate disodium-enhanced MRI AP subtraction imaging to diagnose HCC on T1 low or isosinic lesions, and significantly improved the sensitivity of diagnosing HCC without significant differences in specificity.
    Sex.


    This study expanded the 2018 version of LI-RADS gadoxetate disodium-enhanced MRI AP subtraction imaging to diagnose HCC on T1 low or isosinic lesions, and significantly improved the sensitivity of diagnosing HCC without significant differences in specificity.
    Sex.

    Original source:

    Original source: Original source:

    Seung-Seob Kim, Sunyoung Lee, Heejin Bae, et al.
    Extended application of subtraction arterial phase imaging in LI-RADS version 2018: a strategy to improve the diagnostic performance for hepatocellular carcinoma on gadoxetate disodium-enhanced MRI.
    DOI:
    org/10.
    1007/s00330-020-07229-2">10.
    1007/s00330 -020-07229-2

    Seung-Seob Kim, Sunyoung Lee, Heejin Bae, et al.
    Extended application of subtraction arterial phase imaging in LI-RADS version 2018: a strategy to improve the diagnostic performance for hepatocellular carcinoma on gadoxetate disodium-enhanced MRI.
    DOI:
    org/10.
    1007/s00330-020-07229-2">10.
    1007/s00330 -020-07229-2
    org/10.
    1007/s00330-020-07229-2"> 10.
    1007/s00330-020-07229-2


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