ArticleEuropean radiology2025
Effect of combining serum alpha-fetoprotein with LI-RADS v2018 on gadoxetate-enhanced MRI in the diagnosis and prognostication of hepatocellular carcinoma.
Article in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Magnetic resonance imaging R2* mapping for evaluating Ki-67 proliferation index and cytokeratin 19 expression in solitary iron-sparing hepatocellular carcinoma: a retrospective single-center study.Quantitative imaging in medicine and surgery · 2026Article
- The value of LI-RADS ancillary features and biomarker for hepatocellular carcinoma ≤ 30 mm in Western and Eastern guidelines on extracellular agent and gadoxetic acid-enhanced MRI.European radiology · 2026Article
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9 authors.
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Abstract
objectivesTo evaluate the performance of combining serum alpha-fetoprotein (AFP) with LI-RADS (LI-RADS + AFP) on gadoxetate-enhanced MRI for diagnosing hepatocellular carcinoma (HCC) ≤ 3.0 cm and predicting post-surgical patient outcomes, compared to LI-RADS v2018.
methodsPatients with hepatic observations ≤ 3.0 cm who underwent preoperative gadoxetate-enhanced MRI and surgical resection were retrospectively analyzed. In LI-RADS + AFP, LR-4 (probably-HCC), LR-M (probably or definitely-malignant but not HCC specific), or LR-TIV (definite-tumor-in-vein) by LI-RADS v2018 was upgraded to LR-5 (definitely-HCC) if they met AFP criteria based on three different cut-offs (≥ 20, ≥ 200, ≥ 400 ng/mL). The sensitivity, specificity, and accuracy of LI-RADS v2018 LR-5 and LI-RADS + AFP LR-5 were compared using generalized estimating equations. Recurrence-free survival (RFS) and overall survival (OS) in the two groups (LR-4/5 vs. LR-M) of LI-RADS v2018 and LI-RADS + AFP were compared using log-rank tests.
resultsIn 520 observations from 414 patients (mean age, 60 ± 9 years; 328 men), LI-RADS + AFP ≥ 20 ng/mL (LI-RADS + AFP20) showed the highest accuracy among the three cut-offs. Compared to LI-RADS v2018, LI-RADS + AFP20 showed significantly higher sensitivity in diagnosing HCC (79.9% [95% confidence interval, 75.7-83.6] vs. 71.8% [67.2-76.1], p < 0.001) and accuracy (82.7% [79.2-85.9] vs. 76.9% [73.1-80.5], p < 0.001) without difference in specificity (93.5% [87.1-97.4] vs. 96.3% [90.8-99.0], p = 0.083). Unlike LI-RADS v2018, showing no difference in RFS between LR-4/5 and LR-M (50.6 vs. 42.6 months; p = 0.078), LI-RADS + AFP20 showed significant differences in RFS (50.6 vs. 35.0 months; p < 0.001) and OS (67.6 vs. 54.8 months, p = 0.008).
conclusionCombining AFP and LI-RADS v2018 resulted in better diagnostic performance and superior post-surgical prognostication compared to LI-RADS v2018 alone. KEY POINTS: Question Serum alpha-fetoprotein (AFP) is a commonly used tumor biomarker for hepatocellular carcinoma (HCC), but there are no studies that applied serum AFP in CT/MRI LI-RADS. Findings Combining serum AFP and LI-RADS v2018 had better diagnostic performance for diagnosing HCC ≤ 3.0 cm and superior post-surgical prognostication than LI-RADS v2018 alone. Clinical relevance Integrating serum AFP with LI-RADS v2018 on gadoxetate-enhanced MRI improves the diagnosis and prognostication of HCC patients. These findings provide clinicians with a more robust diagnostic and prognostic framework for managing patients with HCC ≤ 3.0 cm.
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