Use of the LI-RADS classification in patients with cirrhosis due to infection with hepatitis B, C, or D, or infected with hepatitis B and D.

Rita De Cassia Ribeiro Pereira,Carolina Augusta Modena Heming,Thiago Ramos Tejo,Rita Do Socorro Uchoa Da Silva,Thais Cristina Lima De Oliveira,Daniella Braz Parente

doi:10.1590/0100-3984.2018.0077

Abstract

ObjectiveTo evaluate liver lesions, in accordance with the LI-RADS classification, using contrast-enhanced multiphase dynamic computed tomography in patients with hepatitis B, coinfected or not with hepatitis D, or with chronic hepatitis C, as well as to determine the level of agreement between radiologists.Materials and MethodsWe evaluated 38 patients with hepatitis B, coinfected or not with hepatitis D, or with chronic hepatitis C, all of whom underwent contrast-enhanced multiphase dynamic computed tomography. For each examination, two radiologists selected up to three hepatic lesions, categorizing them in accordance with the LI-RADS classification and evaluating signs of chronic liver disease and portal hypertension. To determine the level of agreement between radiologists, we calculated the kappa statistic (κ) .ResultsRadiologist 1 and radiologist 2 selected 56 and 48 liver lesions, respectively. According to radiologist 1 and radiologist 2, respectively, 27 (71%) and 23 (61%) of the 38 patients had at least one liver lesion; 13 (34%) and 12 (32%) had a LI-RADS 5 lesion (κ = 0.821); 19 (50%) and 16 (42%) had a hypervascular lesion (κ = 0.668); and 30 (79%) and 24 (63%) had splenomegaly (κ = 0.503). Both radiologists identified chronic liver disease in 31 (82%) of the patients (κ = 1.00).ConclusionLesions categorized as LI-RADS 5 were detected in approximately 32% of the patients, with almost perfect agreement between the radiologists. The level of agreement was substantial or moderate for the other LI-RADS categories.

Highlights

In Brazil, the estimated incidence of hepatocellular carcinoma (HCC) in 2016 was 10,000 cases, with a crude mortality rate of 5.1/100,000 population, making it the sixth leading cause of cancer-related death in the country[1,2]
We evaluated the hepatic lesions identified by contrast-enhanced multiphase dynamic computed tomography (CT) in accordance with the Liver Imaging Reporting and Data System (LI-RADS) classification in patients with chronic HCV or with hepatitis B virus (HBV), coinfected or not with the hepatitis delta virus (HDV), and looked for signs of chronic liver disease
The present study used the LI-RADS classification system to analyze 38 patients infected with hepatitis viruses (HBV, HCV, HDV, or combinations thereof) who underwent CT

Summary

Introduction

In Brazil, the estimated incidence of hepatocellular carcinoma (HCC) in 2016 was 10,000 cases, with a crude mortality rate of 5.1/100,000 population, making it the sixth leading cause of cancer-related death in the country[1,2]. The main risk factors for HCC are infection with the hepatitis B virus (HBV) and liver cirrhosis, which is present in up to 90% of patients with HCC[3,4]. Pereira RCR et al / LI-RADS in cirrhosis and in hepatitis B and D causes of hepatic cirrhosis are chronic viral hepatitis caused by infection with the hepatitis B virus or the hepatitis C virus (HBV and HCV, respectively), alcoholic cirrhosis, and nonalcoholic fatty liver disease[4]. It is known that HBV is carcinogenic and can lead to the development of HCC even in the absence of cirrhosis[5]. For individuals in the population groups at risk of developing HCC, it is common to undergo abdominal ultrasound screening every six months either with or without determination of the alpha-fetoprotein level. When a focal lesion ≥ 1 cm is identified in the abdominal ultrasound screening, the use of a cross-sectional imaging method, such as contrast-enhanced multiphase dynamic computed tomography (CT) or magnetic resonance imaging (MRI), is indicated in order to confirm the diagnosis and staging[6]

Methods

Results

Conclusion