Impact of Different Degrees of Liver Iron Concentration on
MRI
Feature Assessment and
LI
‐
RADS
v
Sue Cao, Li Jianwen, Xiaorui Su, Xin Gao, Quanxi Li, Jie Zhang, Ruomi Guo ABSTRACT
Background
Hepatocellular carcinoma (HCC) in high‐risk patients can be diagnosed by imaging alone, avoiding biopsy. However, whether liver iron concentration (LIC) affects MRI diagnostic performance remains uncertain.
Purpose
To investigate the impact of different degrees of LIC on MRI feature assessment and LI‐RADS v2018 category assignment in high‐risk HCC patients.
Study Type
Retrospective.
Population
One hundred sixty‐three consecutive HCC patients (mean age, 55.73 ± 9.65 years; 152 male) with 167 lesions.
Field Strength/Sequence
3.0 T. Protocol followed LI‐RADS with extra sequences ( R 2 *, PDFF). Contrast agents included gadoxetate disodium (49 lesions), gadobenate dimeglumine (114 lesions), and Magnevist (4 lesions).
Assessment
According to hepatic R 2 * values, patients were divided into three groups: non‐iron overload (80 lesions), mild (54 lesions), and moderate‐to‐extreme (33 lesions). Three observers independently evaluated LI‐RADS v2018 major, ancillary, and LR‐M features, categories, and T1 signal.
Statistical Tests
ANCOVA/Kruskal‐Wallis H test, chi‐square/Fisher's exact tests, and logistic regression. A two‐sided p < 0.05 was considered statistically significant.
Results
The incidences of T1 iso‐/hyperintensity, nonperipheral “washout”, enhancing “capsule” and HBP hypointensity differed significantly among groups. Moderate‐to‐severe hepatic iron overload independently influenced T1 iso‐/hyperintensity (OR = 14.38 [95% CI: 4.08–50.70]) and nonperipheral “washout” (OR = 0.14 [95% CI: 0.05–0.41]). Hepatic iron overload was independently associated with enhancing “capsule” (mild: OR = 0.34 [95% CI: 0.16–0.72]); moderate‐to‐severe: (OR = 0.15 [95% CI: 0.06–0.37]). HBP hypointensity was influenced by Child‐Pugh class B (OR = 14.51 [95% CI: 1.13–185.88]), total bilirubin (OR = 0.09 [95% CI: 0.83–0.97]), albumin (OR = 1.49 [95% CI: 1.18–1.89]), PLT (OR = 0.99 [95% CI: 0.98–1.00]) and moderate‐to‐severe hepatic iron overload (OR = 0.01 [95% CI: 0.00–0.25]). Proportions of LR‐4 and LR‐5 differed significantly among groups, and only moderate‐to‐severe hepatic iron overload was associated with LR‐5 assignment (OR = 0.08 [95% CI: 0.02–0.28]).
Conclusion
Hepatic iron overload, especially moderate‐to‐extreme, may affect the visual assessment of selected MRI features and alter LI‐RADS v2018 category assignment.
Level of Evidence
3.
Technical Efficacy Stage
2.