Prognosis of Primary Liver Cancer Based on LI-RADS Classification with Extracellular Agent-Enhanced MRI

Yubo Li; Xiaoyan Ni; Xinai Liu; Chun Yang; Yi Wang; Xin Lu; Changwu Zhou

doi:10.2147/JHC.S394840

Prognosis of Primary Liver Cancer Based on LI-RADS Classification with Extracellular Agent-Enhanced MRI

J Hepatocell Carcinoma. 2023 Mar 9:10:399-411. doi: 10.2147/JHC.S394840. eCollection 2023.

Authors

Yubo Li^{1

2

3

4}, Xiaoyan Ni^{2

3

4}, Xinai Liu¹, Chun Yang^{2

3

4}, Yi Wang^{2

4}, Xin Lu^{2

3

4}, Changwu Zhou^{2

3

4}

Affiliations

¹ Department of MRI, Henan Provincial Hospital of Traditional Chinese Medicine (the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine), Zhengzhou, People's Republic of China.
² Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
³ Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.
⁴ Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.

Abstract

Objective: The prognostic value of the Liver Imaging Reporting and Data System (LI-RADS) 2018 in differentiating hepatocellular carcinoma (HCC) from other primary liver cancers (PLC) with cirrhosis is unclear. We aim to evaluate the value of LI-RADS 2018 with agent-enhanced MRI in the postoperative prognosis of PLC patients with cirrhosis.

Methods: Between 2016 and 2021, 432 patients with cirrhosis and surgically proven single primary liver cancer were retrospectively evaluated. Two radiologists evaluated the preoperative MRI features independently and assigned each lesion a LI-RADS category. Overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated by using the Kaplan-Meier method, Log rank test, and Cox proportional hazards model.

Results: The mean age of 432 patients (239 HCCs, 93 ICCs, and 100 cHCC-CCAs) was 57.27±10.92 years. The LR-M category showed poorer OS and RFS than the LR-4 or LR-5 category did for all primary liver cancers (P <0.001 for both), and so did HCCs with tumor size less than 30mm (P =0.003 and P =0.04, respectively). In the multivariable analysis, the LI-RADS category and tumor size > 30 mm had independent correlations with OS and RFS (all P < 0.05). Multivariable Cox analysis identified rim arterial phase hyperenhancement (APHE) as independent determinants of poor OS and RFS in primary liver cancers (all P < 0.05).

Conclusion: The LI-RADS categories can predict the postsurgical prognosis of primary liver cancers independently.

Keywords: hepatocellular carcinoma; liver cirrhosis; magnetic resonance imaging; prognosis.

Grants and funding

This study was supported by Clinical Research Plan of SHDC (grant number SHDC2020CR1029B), National Natural Science Foundation of China (grant number 82171897), Shanghai Municipal Key Clinical Specialty (grant number shslczdzk03202), Clinical Research Project of Zhongshan Hospital, Fudan University (grant number 2020ZSLC61), Henan Provincial Universities Key scientific research projects (grant number 21B320002).