Table 4.
Differences in LI-RADS-defined TIV, LR-M features, and major features in NOS-HCC, SH-HCC, and MTM-HCC subtypes in the entire cohort with contrast-enhanced MRI (n = 227).
| Features | NOS-HCC (n = 165) |
SH-HCC (n = 48) |
MTM-HCC (n = 14) |
p value | R1 vs. R2 N agreement (%) κ value (95% CI) |
R1 vs. R3 N agreement (%) κ value (95% CI) |
R2 vs. R3 N agreement (%) κ value (95% CI) |
|---|---|---|---|---|---|---|---|
| TIV | |||||||
| R1 | 7 (4.2) | 0 (0) | 2 (14.3) | 0.052 | 219 (96.5) | 225 (99.1) | 219 (96.5) |
| R2 | 11 (6.7) | 0 (0) | 4 (28.6) | 0.001 | 0.64 (0.42, 0.87) | 0.88 (0.72, 1.00) | 0.64 (0.42, 0.87) |
| R3 | 7 (4.2) | 0 (0) | 2 (14.3) | 0.052 | |||
| LR-M features | |||||||
| At least 1 LR-M feature | |||||||
| R1 | 65 (39.4) | 10 (20.8) | 6 (42.9) | 0.052 | 177 (78.0) | 182 (80.2) | 184 (83.7) |
| R2 | 66 (40.0) | 11 (22.9) | 4 (28.6) | 0.080 | 0.52 (0.40, 0.63) | 0.55 (0.43, 0.66) | 0.57 (0.45, 0.68) |
| R3 | 51 (30.9) | 11 (22.9) | 6 (42.9) | 0.314 | |||
| At least 1 targetoid feature | |||||||
| R1 | 14 (8.5) | 3 (6.2) | 2 (14.3) | 0.630 | 208 (91.6) | 205 (90.3) | 208 (91.6) |
| R2 | 12 (7.3) | 4 (8.3) | 0 (0) | 0.550 | 0.41 (0.19, 0.62) | 0.39 (0.19, 0.60) | 0.44 (0.23, 0.65) |
| R3 | 15 (9.1) | 4 (8.3) | 2 (14.3) | 0.788 | |||
| Rim APHE | |||||||
| R1 | 8 (4.8) | 3 (6.2) | 2 (14.3) | 0.212 | 214 (94.3) | 212 (93.4) | 211 (93.0) |
| R2 | 6 (3.6) | 2 (4.2) | 0 (0) | 0.750 | 0.35 (0.08, 0.62) | 0.44 (0.21, 0.68) | 0.30 (0.05, 0.54) |
| R3 | 13 (7.9) | 1 (2.1) | 2 (14.3) | 0.365 | |||
| Peripheral ‘washout’ | |||||||
| R1 | 0 (0) | 1 (2.1) | 0 (0) | 0.154 | 226 (99.6) | 223 (98.2) | 224 (98.7) |
| R2 | 0 (0) | 0 (0) | 0 (0) | 1.000 | 0.00 (0.000, 0.00) | −0.006 (−0.01, 0.003) | 0.00 (0.000, 0.00) |
| R3 | 3 (1.8) | 0 (0) | 0 (0) | 0.565 | |||
| Delayed central enhancement | |||||||
| R1 | 6 (3.6) | 0 (0) | 0 (0) | 0.314 | 219 (96.5) | 222 (97.8) | 218 (96.0) |
| R2 | 5 (3.0) | 1 (2.1) | 0 (0) | 0.765 | 0.31 (−0.03, 0.66) | 0.53 (0.17, 0.89) | 0.16 (−0.15, 0.47) |
| R3 | 4 (2.4) | 1 (2.1) | 0 (0) | 0.837 | |||
| Targetoid restriction∗ | |||||||
| R1 | 1 (0.6) | 1 (2.2) | 0 (0) | 0.589 | 215 (99.1) | 210 (96.8) | 212 (97.7) |
| R2 | 1 (0.6) | 1 (2.2) | 0 (0) | 0.079 | 0.49 (−0.10, 1.00) | −0.01 (−0.02, 0.0003) | 0.27 (−0.16, 0.71) |
| R3 | 3 (1.9) | 2 (4.3) | 0 (0) | 0.524 | |||
| Targetoid appearance on HBP | |||||||
| R1 (adequate, n = 59) | 1 (2.3) | 0 (0) | 0 (0) | 0.828 | 38 (97.4) | 38 (97.4) | 39 (100) |
| R2 (adequate, n = 53) | 1 (2.6) | 0 (0) | 0 (0) | 0.818 | 0.00 (0.000, 0.00)† | 0.00 (0.000, 0.00)† | 0.00 (0.000, 0.00)† |
| R3 (adequate, n = 55) | 0 (0) | 0 (0) | 0 (0) | 1.000 | |||
| Infiltrative appearance | |||||||
| R1 | 12 (7.3) | 0 (0) | 2 (14.3) | 0.078 | 219 (96.5) | 219 (96.5) | 221 (97.3) |
| R2 | 10 (6.1) | 0 (0) | 2 (14.3) | 0.076 | 0.67 (0.46, 0.88) | 0.64 (0.42, 0.87) | 0.71 (0.49, 0.83) |
| R3 | 10 (6.1) | 0 (0) | 0 (0) | 0.140 | |||
| Marked restricted diffusion∗ | |||||||
| R1 | 5 (3.2) | 0 (0) | 2 (14.3) | 0.301 | 202 (93.1) | 201 (92.6) | 198 (91.3) |
| R2 | 10 (6.4) | 0 (0) | 2 (14.3) | 0.084 | 0.17 (−0.07, 0.42) | 0.19 (−0.03, 0.42) | 0.16 (−0.07, 0.40) |
| R3 | 11 (7.0) | 0 (0) | 2 (14.3) | 0.085 | |||
| Necrosis or severe ischaemia | |||||||
| R1 | 45 (27.3) | 8 (16.7) | 3 (21.4) | 0.311 | 193 (85.0) | 196 (86.4) | 198 (87.2) |
| R2 | 41 (24.8) | 8 (14.5) | 3 (21.4) | 0.490 | 0.58 (0.46, 0.71) | 0.58 (0.45, 0.71) | 0.59 (0.46, 0.72) |
| R3 | 27 (16.4) | 7 (14.6) | 3 (21.4) | 0.829 | |||
| Major features | |||||||
| Size (mm) | |||||||
| R1 | 44.0 (27.0, 64.5) | 30.0 (19.0, 46.7) | 59.5 (26.0, 100.5) | 0.007 | 0.98 (0.97, 0.98)‡ | 0.98 (0.97, 0.98)‡ | 0.98 (0.97, 0.98)‡ |
| R2 | 46.0 (31.0, 70.0) | 35.0 (23.2, 54.7) | 67.5 (34.0, 130.0) | 0.007 | |||
| R3 | 44.0 (27.0, 71.5) | 30.0 (22.0, 50.2) | 61.0 (23.7, 114.7) | 0.011 | |||
| Non-rim APHE | |||||||
| R1 | 144 (87.3) | 44 (91.7) | 11 (78.6) | 0.406 | 202 (89.0) | 203 (89.4) | 188 (82.9) |
| R2 | 153 (92.7) | 45 (93.8) | 14 (100) | 0.572 | 0.36 (0.51, 0.55) | 0.59 (0.45, 0.74) | 0.24 (0.08, 0.39) |
| R3 | 133 (80.6) | 42 (87.5) | 10 (71.4) | 0.337 | |||
| Non-peripheral ‘washout’ | |||||||
| R1 | 145 (87.9) | 37 (77.1) | 14 (100) | 0.049 | 202 (89.0) | 198 (87.2) | 191 (84.2) |
| R2 | 144 (87.3) | 39 (81.2) | 14 (100) | 0.178 | 0.52 (0.36, 0.68) | 0.54 (0.39, 0.68) | 0.43 (0.26, 0.57) |
| R3 | 131 (79.4) | 39 (81.2) | 13 (92.9) | 0.469 | |||
| Enhancing ‘capsule’ | |||||||
| R1 | 117 (70.9) | 32 (66.7) | 11 (78.6) | 0.673 | 187 (82.4) | 185 (81.5) | 177 (77.9) |
| R2 | 120 (72.7) | 30 (65.5) | 10 (71.4) | 0.391 | 0.57 (0.46, 0.69) | 0.53 (0.41, 0.66) | 0.45 (0.23, 0.58) |
| R3 | 124 (75.2) | 32 (66.7) | 12 (85.7) | 0.293 | |||
| Threshold growth | |||||||
| R1 | 2 (1.2) | 0 (0) | 0 (0) | 0.684 | 223 (98.2) | 221 (97.3) | 221 (97.3) |
| R2 | 1 (0.6) | 0 (0) | 1 (7.1) | 0.032 | −0.008 (−0.01, −0.0001) | 0.24 (−0.15, 0.63) | 0.24 (−0.15, 0.63) |
| R3 | 3 (1.8) | 1 (2.1) | 2 (14.3) | 0.020 | |||
Categorical variables are expressed as numbers and percentages in parentheses. The continuous variable (size) is reported as median and IQR (25th to 75th percentiles) in parentheses. Differences between HCC subtypes were assessed using the Pearson χ2 test for categorical variables. Inter-reader agreement was assessed using the Cohen’s kappa (κ) test for categorical variables and intraclass correlation coefficient of the continuous variable (size). Statistically significant values (p <0.05) are highlighted in bold.
APHE, arterial phase hyperenhancement; HBP, hepatobiliary phase; LI-RADS, Liver Imaging Reporting and Data System; MRI, magnetic resonance imaging; MTM-HCC, macrotrabecular massive hepatocellular carcinoma; NOS-HCC, not otherwise specified hepatocellular carcinoma; R1, Reader 1; R2, Reader 2; R3, Reader 3; SH-HCC, steatohepatitic hepatocellular carcinoma; TIV, tumour-in-vein.
Features assessed in 217/227 observations as a result of the lack of diffusion weighted imaging in 10 observations.
Agreement assessed only in observations considered with adequate HBP for all readers.
Agreement assessed with intraclass correlation coefficient.