Non-alcoholic fatty liver disease-associated hepatocellular carcinoma: Effect of hepatic steatosis on major hepatocellular carcinoma features at MRI

Scott M. Thompson, Ishan Garg, Eric Ehman, Shannon P. Sheedy, Candice A. Bookwalter, Rickey E. Carter, Lewis Rowland Roberts, Sudhakar K Venkatesh

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the effect of hepatic steatosis on LI-RADS® major features at MRI in patients with non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC). Methods: HCC and liver parenchyma features at MRI from 48 consecutive patients with NAFLD and histology proven HCC (mean ± SD; 4.5 ± 3.4 cm) were independently reviewed by three radiologists. Interrater agreement was determined by prevalence/biasadjusted kappa. Hepatic fat signal fraction (FS%) was independently calculated. HCC features were compared by FS% at MRI using logistic regression analysis and histologic steatosis grade using Cochran-Armitage test for trend, stratified by cirrhotic liver morphology or histologic fibrosis stage. Receiver operating characteristic curves were generated to determine the sensitivity and specificity for major HCC features by FS%. Results: Major HCC features included arterial phase hyperenhancement (APHE) in 45 (93%), portal venous phase washout (PVWO) in 30 (63%), delayed phase washout (DPWO) in 38 (79%) and enhancing "capsule" in 34 (71%). Cirrhotic morphology was present in 22 (46%). Inter-rater agreement was 0.75 for APHE, 0.42- 0.58 for PVWO, 0.58-0.71 for DPWO and 0.38-0.67 for enhancing "capsule". There was an 18%, 14% and 22% increase in the odds of absent PVWO, DPWO and capsule appearance for every 1% increase in hepatic FS% in patients with non-cirrhotic liver morphology (p = 0.011, 0.040 and 0.029, respectively). Hepatic FS% ≥ 14.8% had a sensitivity and specificity of 64 and 100% for absent PVWO and 71 and 90% for absent DPWO in patients with non-cirrhotic liver morphology. Conclusion: Absent washout and capsule appearance are associated with increasing hepatic steatosis in patients with non-cirrhotic, NAFLD-associated HCC. Advances in knowledge: In patients with non-cirrhotic, non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC), absent HCC washout and capsule appearance are associated with increasing hepatic steatosis, thereby potentially impacting the noninvasive imaging diagnosis of HCC in these patients. Lack of washout or capsule appearance in steatotic livers at MRI may require alternative criteria for the diagnosis of HCC in patients with non-cirrhotic NAFLD.

Original languageEnglish (US)
Article number20180345
JournalBritish Journal of Radiology
Volume91
Issue number1092
DOIs
StatePublished - Jan 1 2018

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Hepatocellular Carcinoma
Liver
Capsules
Fats
Non-alcoholic Fatty Liver Disease
Sensitivity and Specificity
ROC Curve
Histology
Fibrosis
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Non-alcoholic fatty liver disease-associated hepatocellular carcinoma : Effect of hepatic steatosis on major hepatocellular carcinoma features at MRI. / Thompson, Scott M.; Garg, Ishan; Ehman, Eric; Sheedy, Shannon P.; Bookwalter, Candice A.; Carter, Rickey E.; Roberts, Lewis Rowland; Venkatesh, Sudhakar K.

In: British Journal of Radiology, Vol. 91, No. 1092, 20180345, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Non-alcoholic fatty liver disease-associated hepatocellular carcinoma: Effect of hepatic steatosis on major hepatocellular carcinoma features at MRI",
abstract = "Objective: To evaluate the effect of hepatic steatosis on LI-RADS{\circledR} major features at MRI in patients with non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC). Methods: HCC and liver parenchyma features at MRI from 48 consecutive patients with NAFLD and histology proven HCC (mean ± SD; 4.5 ± 3.4 cm) were independently reviewed by three radiologists. Interrater agreement was determined by prevalence/biasadjusted kappa. Hepatic fat signal fraction (FS{\%}) was independently calculated. HCC features were compared by FS{\%} at MRI using logistic regression analysis and histologic steatosis grade using Cochran-Armitage test for trend, stratified by cirrhotic liver morphology or histologic fibrosis stage. Receiver operating characteristic curves were generated to determine the sensitivity and specificity for major HCC features by FS{\%}. Results: Major HCC features included arterial phase hyperenhancement (APHE) in 45 (93{\%}), portal venous phase washout (PVWO) in 30 (63{\%}), delayed phase washout (DPWO) in 38 (79{\%}) and enhancing {"}capsule{"} in 34 (71{\%}). Cirrhotic morphology was present in 22 (46{\%}). Inter-rater agreement was 0.75 for APHE, 0.42- 0.58 for PVWO, 0.58-0.71 for DPWO and 0.38-0.67 for enhancing {"}capsule{"}. There was an 18{\%}, 14{\%} and 22{\%} increase in the odds of absent PVWO, DPWO and capsule appearance for every 1{\%} increase in hepatic FS{\%} in patients with non-cirrhotic liver morphology (p = 0.011, 0.040 and 0.029, respectively). Hepatic FS{\%} ≥ 14.8{\%} had a sensitivity and specificity of 64 and 100{\%} for absent PVWO and 71 and 90{\%} for absent DPWO in patients with non-cirrhotic liver morphology. Conclusion: Absent washout and capsule appearance are associated with increasing hepatic steatosis in patients with non-cirrhotic, NAFLD-associated HCC. Advances in knowledge: In patients with non-cirrhotic, non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC), absent HCC washout and capsule appearance are associated with increasing hepatic steatosis, thereby potentially impacting the noninvasive imaging diagnosis of HCC in these patients. Lack of washout or capsule appearance in steatotic livers at MRI may require alternative criteria for the diagnosis of HCC in patients with non-cirrhotic NAFLD.",
author = "Thompson, {Scott M.} and Ishan Garg and Eric Ehman and Sheedy, {Shannon P.} and Bookwalter, {Candice A.} and Carter, {Rickey E.} and Roberts, {Lewis Rowland} and Venkatesh, {Sudhakar K}",
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T1 - Non-alcoholic fatty liver disease-associated hepatocellular carcinoma

T2 - Effect of hepatic steatosis on major hepatocellular carcinoma features at MRI

AU - Thompson, Scott M.

AU - Garg, Ishan

AU - Ehman, Eric

AU - Sheedy, Shannon P.

AU - Bookwalter, Candice A.

AU - Carter, Rickey E.

AU - Roberts, Lewis Rowland

AU - Venkatesh, Sudhakar K

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To evaluate the effect of hepatic steatosis on LI-RADS® major features at MRI in patients with non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC). Methods: HCC and liver parenchyma features at MRI from 48 consecutive patients with NAFLD and histology proven HCC (mean ± SD; 4.5 ± 3.4 cm) were independently reviewed by three radiologists. Interrater agreement was determined by prevalence/biasadjusted kappa. Hepatic fat signal fraction (FS%) was independently calculated. HCC features were compared by FS% at MRI using logistic regression analysis and histologic steatosis grade using Cochran-Armitage test for trend, stratified by cirrhotic liver morphology or histologic fibrosis stage. Receiver operating characteristic curves were generated to determine the sensitivity and specificity for major HCC features by FS%. Results: Major HCC features included arterial phase hyperenhancement (APHE) in 45 (93%), portal venous phase washout (PVWO) in 30 (63%), delayed phase washout (DPWO) in 38 (79%) and enhancing "capsule" in 34 (71%). Cirrhotic morphology was present in 22 (46%). Inter-rater agreement was 0.75 for APHE, 0.42- 0.58 for PVWO, 0.58-0.71 for DPWO and 0.38-0.67 for enhancing "capsule". There was an 18%, 14% and 22% increase in the odds of absent PVWO, DPWO and capsule appearance for every 1% increase in hepatic FS% in patients with non-cirrhotic liver morphology (p = 0.011, 0.040 and 0.029, respectively). Hepatic FS% ≥ 14.8% had a sensitivity and specificity of 64 and 100% for absent PVWO and 71 and 90% for absent DPWO in patients with non-cirrhotic liver morphology. Conclusion: Absent washout and capsule appearance are associated with increasing hepatic steatosis in patients with non-cirrhotic, NAFLD-associated HCC. Advances in knowledge: In patients with non-cirrhotic, non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC), absent HCC washout and capsule appearance are associated with increasing hepatic steatosis, thereby potentially impacting the noninvasive imaging diagnosis of HCC in these patients. Lack of washout or capsule appearance in steatotic livers at MRI may require alternative criteria for the diagnosis of HCC in patients with non-cirrhotic NAFLD.

AB - Objective: To evaluate the effect of hepatic steatosis on LI-RADS® major features at MRI in patients with non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC). Methods: HCC and liver parenchyma features at MRI from 48 consecutive patients with NAFLD and histology proven HCC (mean ± SD; 4.5 ± 3.4 cm) were independently reviewed by three radiologists. Interrater agreement was determined by prevalence/biasadjusted kappa. Hepatic fat signal fraction (FS%) was independently calculated. HCC features were compared by FS% at MRI using logistic regression analysis and histologic steatosis grade using Cochran-Armitage test for trend, stratified by cirrhotic liver morphology or histologic fibrosis stage. Receiver operating characteristic curves were generated to determine the sensitivity and specificity for major HCC features by FS%. Results: Major HCC features included arterial phase hyperenhancement (APHE) in 45 (93%), portal venous phase washout (PVWO) in 30 (63%), delayed phase washout (DPWO) in 38 (79%) and enhancing "capsule" in 34 (71%). Cirrhotic morphology was present in 22 (46%). Inter-rater agreement was 0.75 for APHE, 0.42- 0.58 for PVWO, 0.58-0.71 for DPWO and 0.38-0.67 for enhancing "capsule". There was an 18%, 14% and 22% increase in the odds of absent PVWO, DPWO and capsule appearance for every 1% increase in hepatic FS% in patients with non-cirrhotic liver morphology (p = 0.011, 0.040 and 0.029, respectively). Hepatic FS% ≥ 14.8% had a sensitivity and specificity of 64 and 100% for absent PVWO and 71 and 90% for absent DPWO in patients with non-cirrhotic liver morphology. Conclusion: Absent washout and capsule appearance are associated with increasing hepatic steatosis in patients with non-cirrhotic, NAFLD-associated HCC. Advances in knowledge: In patients with non-cirrhotic, non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC), absent HCC washout and capsule appearance are associated with increasing hepatic steatosis, thereby potentially impacting the noninvasive imaging diagnosis of HCC in these patients. Lack of washout or capsule appearance in steatotic livers at MRI may require alternative criteria for the diagnosis of HCC in patients with non-cirrhotic NAFLD.

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