The Study Of The LR3-5 Proportion And Recommended Examination For Intrahepatic Lesions With Inconsistent Blood Supply Characteristics Between Contrast Enhanced-CT And Gd-EOB-DTPA Enhanced MRI

Objective To explore the LR3-5 proportion of intrahepatic lesions with inconsistent blood supply characteristics between contrast enhanced computed tomography(CECT)and Gadolinnium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)in patients with chronic liver disease,and to compare the diagnostic accuracy of Liver Imaging Reporting and Data System(LI-RADS)rating of these intrahepatic lesions with CECT or Gd-EOB-DTPA enhanced MRI alone.Materials and Methods Imaging、clinical and follow-up data of 392(male:253,female:139,age:55±12 years old)consecutive patients(458 lesions,lesions’maximum diameter:22.0±7.5 mm)with chronic liver disease who underwent both CECT and Gd-EOB-DTPA enhanced MRI(intervals≤1 week)from November 2017to August 2018 were retrospectively collected.The blood supply characteristics on arterial phase(AP)、portal venous phase(PVP)、delayed phase(DP)or transisional phase(TP)of each lesion were observed and recorded by two radiologists with experience in abdominal imaging diagnosis and training in LI-RADS v2018 on the same workstation independently and blindly.When the two opinions did not agree,another chief physician with 5 years of experience in abdominal imaging diagnosis joined,then the three discussed and decided together.Select the lesion whose blood supply characteristics were inconsistent on arterial phase(AP)、portal venous phase(PVP)、delayed phase(DP)or transisional phase(TP),tnen evaluated recorded the display of major and auxiliary LI-RADS fetures of each lesion.LI-RADS rating of these lesions were performed based on CECT,Gd-EOB-DTPA enhanced MRI,and combined these two methods.Chi-Square test or Fisher’s exact test was used to compare the recogniaiton proportion of each LI-RADS feature between these two methods、the distribution proportions of LR1-2 and LR3-5using CECT or Gd-EOB-DTPA enhanced MRI alone and combine these two methods.With the lesion as the unit,the LI-RADS classification adjustment between the two inspection methods was calculated and counted.The LI-RADS rating of each lesion based on the two examination methods was used as the final grade,the number of lesions whose LI-RADS grade adjusted was calculated and ROC curve was used to compare the diagnostic accuracy of LI-RADS rating based on CECT and Gd-EOB-DTPA enhanced MRI alone.Selected lesions with postoperative pathological or follow-up data from the lesions whose blood supply characteristics were inconsistent on arterial phase(AP)、portal venous phase(PVP)、delayed phase(DP)or transisional phase(TP)to test and verify the accuracy of lesion grading by two inspection methods.Think of LR-1-2 as benign lesions and LR3-5 as HCC,and with the pathology or follow-up results as the gold standard.Calculate the sensitivity,specificity,positive predictive value,and negative predictive value of LI-RADS classification of the above-mentioned intrahepatic lesions using two inspection methods,and ROC curve was used to compare the accuracy of LI-RADS classification of the lesions using two inspection methods.Results The intrahepatic lesions with inconsistent blood supply characteristics between CECT and Gd-EOB-DTPA enhanced MRI accounted for 34.72%(159/458),and 77.99%(124/159)were LR3-5.The recogniaiton proportion of non-rim AP hyperenhangcement、nonperipheral“wash-out”、enhancing“capsule”and mosaic architecture by Gd-EOB-DTPA enhanced MRI was significantly higher than CECT(59.75%VS.44.65%,?~2=7.259,P=0.007;54.72%VS.42.77%,?~2=4.544,P=0.033;24.53%VS.10.69%,?~2=10.49,P=0.001;19.50%VS.8.18%,?~2=8.546,P=0.003).Compared with LI-RADS rating results of CECT,71 lesions were upgraded by Gd-EOB-DTPA enhanced MRI and 2 lesions were downgraded by Gd-EOB-DTPA enhanced MRI from LR-4 to LR-2.The diagnosis accuracy of lesions grading LR3-5 by Gd-EOB-DTPA enhanced MRI alone(AUC value=0.980)was significantly higher than that using CECT alone(AUC value=0.746,P<0.001).With the pathology or follow-up results as the gold standard,the diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI(AUC=0.860)was significantly higher than that of CECT(AUC=0.752,Z=1.990,P=0.0466).Conclusion In patients with chronic liver disease,the proportion of intrahepatic lesions showed inconsistent blood supply characteristics between CECT and Gd-EOB-DTPA enhanced MRI is very high,and most of them rating LR3-5.Gd-EOB-DTPA enhanced MRI is more accurate for the LI-RADS rating of these lesions than CECT.