American Journal of Roentgenology最新文献

Background: The LI-RADS version 2018 (v2018) diagnostic algorithm prioritizes an enhancing capsule differently from other major features. An enhancing capsule's role in hepatocellular carcinoma (HCC) diagnosis remains uncertain, particularly for CT. Objective: To compare diagnostic performance for HCC diagnosis on CT between original LI-RADS v2018 criteria for LR-5 and modified LR-5 criteria that treat an enhancing capsule the same as other major features. Methods: This retrospective study included 546 patients (mean age, 59.8±9.6 years; 432 men, 114 female) at risk for HCC who underwent dynamic liver CT within 1 month before partial hepatectomy or liver transplant between January 2022 and December 2023. Two radiologists independently assessd hepatic observations (n=645) for LI-RADS major features, resolving discrepances with a third radiologist. LI-RADS categories were assigned using original LR-5 criteria and modified criteria giving an enhancing capsule the same priority as other major features (nonperipheral washout and threshold growth). The reference standard was pathologic assessment or ≥2 years of imaging follow-up. Criteria were compared using generalized estimating equations. Results: Sensitivity, specificity, PPV, NPV, and accuracy for reader 1 with original LR-5 criteria were 72.7%, 89.2%, 96.8%, 43.0%, and 75.2%; for reader 1 with modified criteria were 75.7%, 88.4%, 96.7%, 45.5%, and 77.5%; for reader 2 with original LR-5 criteria were 72.8%, 91.1%, 97.3%, 43.6%, and 75.6%; and for reader 2 with modified criteria were 75.0%, 90.3%, 97.1%, 45.4%, and 77.3%, respectively. For both readers, sensivitiy and accuracy were significantly higher for modified than for original criteria (p<.05); specificity, PPV, and NPV were not significantly different between criteria (p>.05). Among observations measuring 10-19 mm with nonrim arterial-phase hyperenhancement, using consensus assessments, sensitivity, specificity, PPV, NPV, and accuracy for original LR-5 criteria were 52.5%, 84.0%, 95.5%, 19.4%, and 56.3%; and for modified criteria were 64.9%, 78.3%, 95.1%, 23.2%, and 66.4%, respectively. Conclusion: When applying LI-RADS v2018 on CT, treating an enhancing capsule the same as other major features provided significantly increased sensitivity for HCC detection without significant change in specificity or PPV. Clinical Impact: Treating enhancing capsule the same as other major features for CT-based LI-RADS could improve noninvasive HCC diagnosis while simplifying interpretations.

Background: As pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) increases in prevalence, ultrasound-based methods have emerged as accessible alternatives to MRI for hepatic fat quantification in children. Objective: To evaluate associations of ultrasound-derived fat fraction (UDFF) measurements obtained under free-breathing and breath-hold conditions with proton-density fat fraction (PDFF) measurements in pediatric patients with suspected MASLD. Methods: This prospective study enrolled pediatric patients with clinical suspicion for MASLD from November 2023 to October 2024. Participants underwent an investigational liver MRI examinations with PDFF measurement and an investigational right upper quadrant ultrasound with UDFF measurements under both breath-hold and free-breathing conditions. A second operator repeated the ultrasound examinations in the first 14 patients to assess interobserver agreement. Concordance correlation coefficients (CCC) and Spearman correlation coefficients were computed. Bland-Altman analyses were conducted, including linear regression fits. Results: The study included 55 patients (33 male, 22 female; mean age, 13.8±2.6 years; age range, 9-18 years). PDFF measurements ranged from 0.1% to 56.1%; UDFF measurements ranged from 2.0% to 36.2%. UDFF measurements showed good interobserver agreement under breath-hold (CCC=0.79) and free-breathing (CCC=0.76) conditions and excellent agreement between breath-hold and free-breathing conditions (CCC=0.97). UDFF and PDFF measurements showed strong positive correlations under breath-hold (ρ=0.84) and free-breathing (ρ=0.83) conditions. In Bland-Altman analysis, UDFF showed no significant systematic bias versus PDFF under breathhold condition (mean difference, -2.0%) but significant systematic underestimation bias under free-breathing condition (-2.6%); UDFF and PDFF showed a significant inverse proportional bias under both conditions (β=-0.5, p<.001). In patients with PDFF <5% (n=28), UDFF showed a significant systematic overestimation bias versus PDFF under breathing-hold (2.0%) and free-breathing (2.1%) conditions; in patients with PDFF ≥5% (n=27), UDFF showed a significant systematic underestimation bias versus PDFF under breath-hold (-6.3%) and free-breathing (-7.4%) conditions. Conclusion: UDFF measurements in both breath-hold and free-breathing conditions showed strong positive correlations with PDFF measurements in children. However, UDFF overestimated and underestimated PDFF in patients with relatively low and high liver fat content, respectively. Clinical Impact: UDFF may have a role in screening for steatosis in children with suspected MASLD, although clinical integration must account for systematic biases between UDFF and PDFF measurements.