Magnetic Resonance Widened Diagnostic Criteria for Hepatocellular Carcinoma

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Purpose: To assess the added value of specific MR imaging ancillary criteria used in a comprehensive radiological diagnostic guideline (Valencia multivariate classification, VLC-MV) for the non-invasive diagnosis of hepatocellular carcinoma (HCC). Material and Methods: Descriptive observational retrospective study of 66 patients diagnosed with HCC. MR was performed on different 1.5 and 3T scanners. Standard gradient echo chemical shift T1-weighted, turbo-spin echo T2-weighted, diffusion-weighted with high b-values (800-1,000 s/mm²) and dynamic contrast-enhanced spoiled gradient echo T1-weighted (late arterial, portal and equilibrium phases) sequences were used. All cases were evaluated using the EASL-AASLD, LI-RADS and VLC-MV criteria. The VLC-MV classification developed in our center considers the added value of several different ancillary minor criteria (at least one vascular major criteria plus at least two minor criteria: capsule, fatty metamorphosis, mosaic pattern, signal changes on T1-weighted and T2-weighted sequences, restricted diffusion and vascular invasion) and does not include growth or size in order to minimise difficulties and biases. The VLC-MV criteria will be compared to the most widely used and established guidelines (EASL-AASL and LI-RADS). Results: Mean HCC size was 38.6 ± 26 mm (standard deviation), range from 7 to 120 mm. There were 6 hypovascular tumours (9.1%) and 4 (6.1%) without wash-out. Regarding minor ancillary criteria, capsule was observed in 57 cases (86.4%), fatty metamorphosis in 11 (16.7%), T1-/T2 slight signal changes in 18 (27.3%), mosaic pattern in 5 (7.6%), diffusion hyperintensity in 45 (68.2%) and vascular invasion in 6 cases (9.1%). The VLC-MV was the most accurate classification (98.5% positive predictive value), followed by LI-RADS (84.8% for LI-RADS-5) and EASL-AASLD (80.3%), the differences being significant (Chi-Squared test, p=0.04 and 0.02). Conclusions: MR imaging VLC-MV classification is a very accurate method for the non-invasive diagnosis of HCC, with the advantages of not requiring the evaluation of growth and not being limited by lesion size.