ArticleBMC medical imaging2025
Enhanced diagnostic performance for subcentimeter hepatocellular carcinoma using a novel criterion integrating serum AFP levels and gadolinium-based contrast-enhanced MRI features.
Article in BMC medical imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo assess the effectiveness of LI-RADS v2018 and r-LI-RADS in diagnosing subcentimeter hepatocellular carcinoma (HCC) and to evaluate the potential value of serum alpha-fetoprotein (AFP) in conjunction with gadolinium-based contrast-enhanced MRI (CE-MRI) for assessing these lesions.
methodsThis retrospective study included 179 untreated, high-risk patients with microlesions (< 1 cm) from 2015 to 2023. Of these, 92 lesions were pathologically confirmed as HCC, the remaining 87 were non-HCC. Two radiologists independently rated imaging features using LI-RADS and r-LI-RADS. The optimal AFP threshold for HCC diagnosis was determined by the Youden index. Logistic regression analyses identified independent predictors of micro-HCC, leading to the development of new diagnostic criteria.
resultsMultivariate analysis identified AFP > 12.15 ng/mL, non-peripheral arterial phase enhancement, diffusion restriction, fat deposition, and enhancing capsule as key independent factors for diagnosing micro-HCC. A new criterion requiring at least three positive factors improved sensitivity to 78.3% vs. 58.7% for LR-4 (p = 0.001), with similar specificity (83.9% vs. 81.6%, p = 0.824). It also outperformed r-LR-5/4 and r-LR-4 in sensitivity (78.3% vs. 59.8% and 58.7%, both p = 0.001), without impacting specificity.
conclusionA new criterion (at least three positive findings among AFP > 12.15 ng/mL, non-peripheral arterial phase enhancement, diffusion restriction, fat deposition, and enhancing capsule) significantly improves the diagnostic sensitivity for subcentimeter HCC while maintaining high specificity, demonstrating clear advantages over the LR-4, r-LR-5/4, and r-LR-4 standards of LI-RADS.
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