A Computed Tomography Nomogram for Assessing the Malignancy Risk of Focal Liver Lesions in Patients With Cirrhosis: A Preliminary Study.

Hongzhen Wu,Ruimeng Yang,Lei Mo,Zihua Wang,Caihong Tan,Wanli Zhang,Xinhua Wei,Xinqing Jiang,Yingying Liang

doi:10.3389/fonc.2021.681489

Abstract

PurposeThe detection and characterization of focal liver lesions (FLLs) in patients with cirrhosis is challenging. Accurate information about FLLs is key to their management, which can range from conservative methods to surgical excision. We sought to develop a nomogram that incorporates clinical risk factors, blood indicators, and enhanced computed tomography (CT) imaging findings to predict the nature of FLLs in cirrhotic livers.MethodA total of 348 surgically confirmed FLLs were included. CT findings and clinical data were assessed. All factors with P < 0.05 in univariate analysis were included in multivariate analysis. ROC analysis was performed, and a nomogram was constructed based on the multivariate logistic regression analysis results.ResultsThe FLLs were either benign (n = 79) or malignant (n = 269). Logistic regression evaluated independent factors that positively affected malignancy. AFP (OR = 10.547), arterial phase hyperenhancement (APHE) (OR = 740.876), washout (OR = 0.028), satellite lesions (OR = 15.164), ascites (OR = 156.241), and nodule-in-nodule architecture (OR =27.401) were independent predictors of malignancy. The combined predictors had excellent performance in differentiating benign and malignant lesions, with an AUC of 0.959, a sensitivity of 95.24%, and a specificity of 87.5% in the training cohort and AUC of 0.981, sensitivity of 94.74%, and specificity of 93.33% in the test cohort. The C-index was 96.80%, and calibration curves showed good agreement between the nomogram predictions and the actual data.ConclusionsThe nomogram showed excellent discrimination and calibration for malignancy risk prediction, and it may aid in making FLLs treatment decisions.

Highlights

It is challenging for abdominal radiologists to detect and characterize focal liver lesions (FLLs) in patients with cirrhosis [1,2,3]
Neoplasm (n = 1), combined hepatocellular carcinoma (HCC)- cholangiocarcinoma (n = 1), cyst (n = 32), hemangioma (n = 14), abscess (n = 10), focal nodular hyperplasia (n = 10), regenerative nodules (n = 4), adenoma (n = 4), parasitization (n = 2), extramedullary hemopoiesis (n = 2), and tuberculosis (n = 1). These FLLs were either benign (n = 79) or malignant (n = 269), as shown in Figure 1, and the baseline characteristics of the patients are shown in Table 1 and Table 2
A total of 348 FLLs were identified in the patients, including

Summary

Introduction

It is challenging for abdominal radiologists to detect and characterize focal liver lesions (FLLs) in patients with cirrhosis [1,2,3]. Cirrhosis is a major risk factor for hepatocellular carcinoma (HCC) [4]. In cirrhotic livers, these lesions may lack typical imaging features [1]. The final diagnosis may need to be verified by tissue sampling [1, 5]. Accurate descriptions of FLLs guide their management, which ranges from conservative treatment to surgical excision [6]. Proper identification can prevent unnecessary biopsy and allow the appropriate treatment to be selected [5, 7]

Methods

Results

Conclusion