Journal of Liver Cancer

Original Articles

Re-assessing the diagnostic value of the enhancing capsule in hepatocellular carcinoma imaging: Jae Seok Bae, Jeong Min Lee, Bo Yun Hur, Jeongin Yoo, Sae-Jin Park; J Liver Cancer. 2024;24(2):206-216. Published online May 8, 2024; DOI: https://doi.org/10.17998/jlc.2024.05.01

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Backgrounds/Aims
The enhancing capsule (EC) in hepatocellular carcinoma (HCC) diagnosis has received varying degrees of recognition across major guidelines. This study aimed to assess the diagnostic utility of EC in HCC detection.
Methods
We retrospectively analyzed patients who underwent pre-surgical computed tomography (CT) and hepatobiliary agent-enhanced magnetic resonance imaging (HBA-MRI) between January 2016 and December 2019. A single hepatic tumor was confirmed based on the pathology of each patient. Three radiologists independently reviewed the images according to the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria and reached a consensus. Interobserver agreement for EC before reaching a consensus was quantified using Fleiss κ statistics. The impact of EC on the LI-RADS classification was assessed by comparing the positive predictive values for HCC detection in the presence and absence of EC.
Results
In total, 237 patients (median age, 60 years; 184 men) with 237 observations were included. The interobserver agreement for EC detection was notably low for CT (κ=0.169) and HBA-MRI (κ=0.138). The presence of EC did not significantly alter the positive predictive value for HCC detection in LI-RADS category 5 observations on CT (94.1% [80/85] vs. 94.6% [88/93], P=0.886) or HBAMRI (95.7% [88/92] vs. 90.6% [77/85], P=0.178).
Conclusions
The diagnostic value of EC in HCC diagnosis remains questionable, given its poor interobserver agreement and negligible impact on positive predictive values for HCC detection. This study challenges the emphasis on EC in certain diagnostic guidelines and suggests the need to re-evaluate its role in HCC imaging.

Citations

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Value of enhancing capsule for diagnosing hepatocellular carcinoma on MRI: implications for simplifying LI-RADS
Se Jin Choi, Hae Young Kim, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin, Sang Hyun Choi, Jae Ho Byun
European Radiology.2025;[Epub] CrossRef

Inter-reader agreement for CT/MRI LI-RADS category M imaging features: a systematic review and meta-analysis: Dong Hwan Kim, Sang Hyun Choi; J Liver Cancer. 2024;24(2):192-205. Published online April 15, 2024; DOI: https://doi.org/10.17998/jlc.2024.04.05

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4 Citations

Abstract PDF Supplementary Material

Backgrounds/Aims
To systematically evaluate inter-reader agreement in the assessment of individual liver imaging reporting and data system (LI-RADS) category M (LR-M) imaging features in computed tomography/magnetic resonance imaging (CT/MRI) LIRADS v2018, and to explore the causes of poor agreement in LR-M assignment.
Methods
Original studies reporting inter-reader agreement for LR-M features on multiphasic CT or MRI were identified using the MEDLINE, EMBASE, and Cochrane databases. The pooled kappa coefficient (κ) was calculated using the DerSimonian-Laird random-effects model. Heterogeneity was assessed using Cochran’s Q test and I² statistics. Subgroup meta-regression analyses were conducted to explore the study heterogeneity.
Results
In total, 24 eligible studies with 5,163 hepatic observations were included. The pooled κ values were 0.72 (95% confidence interval [CI], 0.65-0.78) for rim arterial phase hyperenhancement, 0.52 (95% CI, 0.39-0.65) for peripheral washout, 0.60 (95% CI, 0.50-0.70) for delayed central enhancement, 0.68 (95% CI, 0.57-0.78) for targetoid restriction, 0.74 (95% CI, 0.65-0.83) for targetoid transitional phase/hepatobiliary phase appearance, 0.64 (95% CI, 0.49-0.78) for infiltrative appearance, 0.49 (95% CI, 0.30-0.68) for marked diffusion restriction, and 0.61 (95% CI, 0.48-0.73) for necrosis or severe ischemia. Substantial study heterogeneity was observed for all LR-M features (Cochran’s Q test, P<0.01; I²≥89.2%). Studies with a mean observation size of <3 cm, those performed using 1.5-T MRI, and those with multiple image readers, were significantly associated with poor agreement of LR-M features.
Conclusions
The agreement for peripheral washout and marked diffusion restriction was limited. The LI-RADS should focus on improving the agreement of LR-M features.

Citations

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Intrahepatic Lymphoid Follicles Comprising T and B Cells Mimic Hepatocellular Carcinoma in a Hepatitis B Patient
Ji Yeon Lee, Jaejun Lee, Pil Soo Sung
International Journal of Molecular Sciences.2025; 26(10): 4823. CrossRef
Concurrent AI assistance with LI-RADS classification for contrast enhanced MRI of focal hepatic nodules: a multi-reader, multi-case study
Xiang Qin, Lisheng Huang, Yuanfeng Wei, Hongxiang Li, Yuting Wu, Jingmeng Zhong, Mingjue Jian, Jing Zhang, Zeyu Zheng, Yikai Xu, Chenggong Yan
Abdominal Radiology.2025;[Epub] CrossRef
LR-M for CT/MRI on LI-RADS v2018: a review of imaging criteria, performance, challenges and future directions from an end-user perspective
Gavin Low, Tyler Pfanner, Xu Jing Qian, Ali Ramji, Karim Samji, Mitchell P. Wilson
Abdominal Radiology.2025;[Epub] CrossRef
Inter-reader agreement for LR-M imaging features: a premise for better imaging-based diagnosis in liver imaging
Jaeseung Shin
Journal of Liver Cancer.2024; 24(2): 124. CrossRef

Review Article

Combination of interventional oncology local therapies and immunotherapy for the treatment of hepatocellular carcinoma: Dong-Hyun Kim; J Liver Cancer. 2022;22(2):93-102. Published online April 22, 2022; DOI: https://doi.org/10.17998/jlc.2022.03.28

13,343 Views
270 Downloads
21 Citations

Abstract PDF

Interventional oncology (IO) local therapies of hepatocellular carcinoma (HCC) can activate anti-cancer immunity and it is potentially leading to an anti-cancer immunity throughout the body. For the development of an effective HCC treatment regime, great emphasis has been dedicated to different IO local therapy mediated immune modulation and possible combinations with immune checkpoint inhibitor immunotherapy. In this review paper, we summarize the status of combination of IO local therapy and immunotherapy, as well as the prospective role of therapeutic carriers and locally administered immunotherapy in advanced HCC.

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