To evaluate the diagnostic value of MRI Liver Image Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) in patients with non-cirrhotic hepatitis B.

Clinical data of 161 patients who were diagnosed with non-cirrhotic chronic hepatitis B by laboratory and histopathological examination and received enhanced abdominal MRI scanning in the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to December 2018 were retrospectively analyzed. Among them, 127 patients were male and 34 female, aged from 28 to 71 years, with a median age of 49 years. This study was approved by the ethical committee of our hospital, and the requirement of informed consent was exempted. MRI images of 161 patients were simultaneously classified according to LI-RADS v2018 by two radiologists. A consensus was reached to obtain the final diagnostic result of LI-RADS v2018, which was compared with the gold standard. Pathological results were regarded as the gold standard for malignant lesions and the results of clinical and radiological follow-up for at least 2 years were considered as the gold standard for benign lesions. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy ofLI-RADS v2018 in diagnosing HCC were calculated.

There were 161 lesions in 161 patients, including 71 HCC lesions, 23 non-HCC malignant tumors and 67 benign lesions. 138 lesions were finally diagnosed by pathological examination, and 23 cases were confirmed by clinical and MRI images during follow-up. Among MRI enhancement features, non-circular enhancement in arterial phase accounted for 67.1% (108/161), 83.9% (135/161) for diffusion limitation and 80.1% (129/161) for slightly high T2WI signal, respectively. 6, 43, 15, 12, 70 and 15 lesions were classified as LR-1, LR-2, LR-3, LR-4, LR-5 and LR-M by LI-RADS, respectively. There were 64 cases of HCC, 5 cases of non-HCC malignant tumors and 1 case of hepatic adenoma in LR-5. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LR-5 in diagnosing HCC were 0.901, 0.933, 0.914, 0.923 and 91.2%, respectively. In LR-M, 4 cases were HCC and 11 cases were non-HCC malignant tumors.

Enhanced MRILI-RADS evaluation system has high diagnostic value for HCC in patients with non-cirrhotic hepatitis B, which yields high sensitivity, specificity, positive predictive value, negative predictive value and accuracy.