Instructions for Authors — Korean Journal of Radiology
Source: https://www.kjronline.org/index.php?body=instruction
Publication Instructions for Authors
(last updated: March 2026)
Korean Journal of Radiology Editorial Office
71, Yangjaecheon-ro, Seocho-gu,
Seoul 06754, Korea.
Tel. 82-2-578-8003
Fax. 82-2-529-7113
e-mail:
[email protected]AIMS AND SCOPE
The
Korean Journal of Radiology, the official English language journal of the Korean Society of Radiology, publishes original contributions valuable to the advancement of radiologic diagnosis and treatment.Korean Journal of Radiologydoes not publish articles in the fields of radiation oncology, dentistry, dental radiology, and dental surgery. While it publishes nuclear medicine studies directly relevant to clinical patient management, especially in oncology practice, it does not consider manuscripts that focus on the technical development, modification, or improvement of nuclear medicine imaging. Additionally, it does not consider translational and basic research studies in nuclear medicine. Such studies may be more suitable for journals dedicated to nuclear medicine. The journal releases a new issue every month by the first day of each month.We will undertake the evaluation of your manuscript with the understanding that the study followed the journal’s policies and guidelines explained hereinafter and in the Research and Publication Ethics statement of the journal (
https://kjronline.org/index.php?body=ethics) and the Good Publication Practice Guideline for Medical Journals by the Korean Association of Medical Journal Editors. Studies submitted toKorean Journal of Radiologyshould also follow established guidelines for reporting research studies (http://www.equator-network.org). All prospective clinical trials need to be registered at an appropriate online public registry (http://www.icmje.org/about-icmje/faqs/clinical-trials-registration/).REDUNDANT PUBLICATION AND RESEARCH ETHICS
All submitted manuscripts should be original and unpublished elsewhere in part or entirety in the same or different languages. They also should not be under review by other scientific journals for publication. We accept the submission of manuscripts that have previously been posted on a nonprofit preprint server. Authors should notify the journal of any preprint related to a manuscript submission.
If authors believe their manuscript might not fulfill these requirements, they should consult the editor regarding this in a cover letter and should clearly state the reuse/overlap of study materials in the ‘Materials and Methods’ section of the manuscript. The authors should explain how their reports overlap with published materials or how they differ. A copy of such material previously published or considered for publication elsewhere should also be submitted.
AUTHORSHIP
Each author must meet the criteria established by the International Committee of Medical Journal Editors (ICMJE) to be included in the article byline, including 1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; 3) final approval of the version to be published; and 4) agreeing to be accountable for all aspects of the work in ensuring that the questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Acquisition of funding, data collection, or general supervision of the research group alone does not constitute authorship. Individuals who have contributed substantially to some (but not all) of the four categories, or in other areas, should be listed in Acknowledgments. The description of equal contribution, so-called co-first authors or co-corresponding authors, is allowed for up to two people. It should first be explicitly explained to the editor in the cover letter how the two authors’ contributions are equal.
Changing authorship is possible during revision, if appropriate according to the additional contributions needed for revision. However, once the decision of acceptance is made, adding authors or changing the first or the corresponding authors is not allowed. Any changes in authorship, including change in name order, need to be reported to the editorial office in a letter explaining the reasons for the changes, signed by all authors indicating their agreement with the changes. The Editor may decline any inappropriate changes.
ETHICAL AND RESPONSIBLE USE OF GENERATIVE ARTIFICIAL INTELLIGENCE (AI)
•
AI tools must not be listed as authors or cited as a primary scholarly source.
Authors remain fully responsible and accountable for all submitted content and shall be accountable for any ethical or legal breach.
KJR allows authors to use AI tools ethically and responsibly in manuscript preparation, provided that such use does not replace the essential intellectual and scholarly contributions of human authors.
When AI tools are used beyond routine linguistic assistance, their use must be clearly disclosed, with sufficient detail. Disclosure can be provided in the relevant section of the manuscript or in the Acknowledgments section.
When AI itself is the subject of investigation, its use must be explicitly described in the Materials and Methods section.
Reviewers and editors must safeguard the confidentiality of unpublished manuscripts. Uploading manuscript content or review text to AI services is prohibited unless confidentiality can be reliably assured.
Reviewers and editors may use AI tools for non-core, assistive purposes under their supervision. However, core human reviewer functions must not be delegated to AI. Reviewers and editors are prohibited from using AI tools to substitute these core human functions or for the primary purpose of generating peer-review comments.
Reviewers and editors who use AI tools beyond routine linguistic assistance in the peer-review process must disclose such use to the journal.
Please refer to
https://doi.org/10.3348/kjr.2026.0166for further details.CONFLICT OF INTEREST
A conflict of interest may exist when an author (or the author’s institution or employer) has financial or personal relationships or affiliations that could influence (or bias) the author’s decisions, work, or manuscript. All authors are required to report potential conflicts of interest, including specific financial interests relevant to the subject of their manuscript, on the unblinded full title page. The authors will also be asked by the journal to fill the ICMJE Form for Disclosure of Potential Conflicts of Interest.
MANUSCRIPT TYPES
The article types that
Korean Journal of Radiologypublishes are summarized in the below table.•
We do not publish study protocols except for rare exceptions.
Authors are advised to adhere to the journal’s recommended guidelines on word count, figures, tables, and references. Manuscripts that significantly exceed these limits may be returned to the authors prior to review.
| Type | Format Requirements and Word Count | Figure Number | Notes | || | Abstract | Body Text* | |||| | Original Research (including meta-analysis) | Original Article | ≤300 words; structured including Objective, Materials and Methods, Results, and Conclusion sections | ≤3000 words; structured including Introduction, Materials and Methods, Results, and Discussion sections | ≤7 figures † | | | Brief Research Report | ≤300 words; structured including Objective, Materials and Methods, Results, and Conclusion sections | ≤2000 words; structured including Introduction, Materials and Methods, Results, and Discussion sections | ≤4 figures †and/or tables | Short original research paper reporting an evaluation of unique previously unreported techniques, procedures, or case series that include a small number of subjects. Formal statistical analysis (such as Pvalues) may not be needed. | | | Education | Review | ≤200 words; unstructured | ≤5000 words | ≤10 figures † | Narrative comprehensive scholarly review on a particular topic; generally invited by editor(s) | | Pictorial Essay | ≤200 words; unstructured | ≤2000 words | ≤20 figures † | More illustrative than narrative explanations on a particular topic. | | | Focus | ≤200 words; unstructured | ≤2000 words | ≤4 figures †and/or tables | Shorter, timely summary and discussion on a focused issue, which may contain slightly more opinion-based information than typical scholarly review articles; generally invited by editor(s). | | | Recommendation and Guideline | ≤200 words; unstructured | Recommendations and guidelines for radiology practice from authoritative, recognized medical groups or societies. Must be supported by published scientific studies or acknowledged expert panels and be approved by the medical groups or societies before submission. | ||| | Editorial | No abstract | ≤1000 words | ≤2 figures †and/or tables | Includes the policies and views of the journal; the perspectives and opinions of a person, group, or organization (not necessarily that of the journal); commentaries on articles published in the journal; interviews; and summary of symposia or conference. Written by editors or generally invited by editor(s). References ≤20. | | | Uncover This Tech Term | No abstract | ≤1000 words | ≤2 figures †and/or tables | Quick and convenient references for recent technology-related terms and concepts, encompassing areas such as AI, imaging techniques, statistical analysis, and more. Each term is defined and summarized, accompanied by illustrative examples showcasing its applications. The title should be as “Uncover This Tech Term: xxx.” For more information, please see https://doi.org/10.3348/kjr.2023.0700. References ≤20. | | | Emerging Rad Dx | No abstract | ≤1000 words | ≤2 figures †and/or tables | Explains novel or emerging diseases/conditions (also including new disease definitions or classifications) that have substantial radiological relevance and health implications, using exemplary cases. Unlike general case reports, our priority is to raise immediate awareness among radiologists rather than focusing solely on rarity or unusual findings as selection criteria. For more information, please see https://doi.org/10.3348/kjr.2023.0700. References ≤20. | | | Letter to the Editor | No abstract | ≤800 words; unstructured without section headings | ≤2 figures †and/or tables | Letters are typically concerning material previously published in Korean Journal of Radiology. Original data or exemplary cases may be included if they are relevant to the comment. One table may be included, if necessary. References ≤10. | |
*Excludes title, abstract, keywords, references, tables, and figure legends. Article types that do not require a specific structural format except for Letter to the Editor may use section headings appropriately to improve readability.
†A figure may contain multiple parts; for example, Fig. 1A-C and Fig. 2A-D will be counted as two figures instead of seven. Use figure parts or composite figures appropriately to avoid an excessive number of figures.
MANUSCRIPT FORMATTING
- General Guidelines
The manuscript must be written in English. Please be aware that unclear use of the English language, which hinders our ability to understand the manuscript, is a reason for editorial rejection. We strongly recommend that authors who are not confident in the linguistic quality of their manuscript seek assistance from professional academic English proofreading services or use proofreading software tools to improve the language quality.
For medical terms such as proper nouns, generic names of medicines, and units of measurement, use the original term. The use of acronyms and abbreviations is discouraged and should be kept to a minimum. When used, they are to be defined where first used, followed by the acronym or abbreviation in parentheses. Measurements and laboratory values should be in accordance with the
International System of Units(SI) (resources: “SI Units in Radiation Protection and Measurements, NCRP Report no. 82” [August 1985]; “Now Read This: The SI Units Are Here,”JAMA1986;255:2329-2339).•
Large numbers should be written with commas separating every three digits for readability (e.g., 123,456,789).
Do not use more than one decimal place for reporting % (i.e., x.x%, not x.xx%).
Report
Pvalues to three decimal places (i.e., 0.xxx). ForPvalues less than 0.001, report as “P< 0.001.”•
It is not necessary to describe geographic information (city, country) for all commercial products (scanner, equipment, device, catheter, drug, contrast material, tracer, software, etc).
All text files should be in Microsoft Word format (doc or docx). Do not upload texts files as pdfs.
The manuscript should use 12-point font size and be double spaced on 21.6 cm by 27.9 cm (letter size) or 21.0 cm by 29.7 cm (A4) paper, with an approximate 3-cm margins.
Authors should not number the pages or the lines. The page and line numbers will automatically be generated when an uploaded manuscript is converted to pdf format, with the blinded title page being page 1.
Korean Journal of Radiologyperforms double-blinded review of the submitted manuscripts. Authors’ names or initials, their affiliations, or any other remarks that may identify the authors should not appear in the blinded Main Document, Figures, or any other materials for review. In case those are found, the editorial office will ask the authors to reupload the files after hiding them or will delete them on behalf of the authors before sending the manuscript for peer review.
Do not mix tables or figures with the text. Tables and figures should be placed collectively in the Main Document after references on separate pages.
For the initial submission, embed figures in the Word file as JPG/JPEG images. For a revised submission, do not embed figures in the Word file. Instead, upload figures as separate image files.
Authors should appropriately describe the sex or gender of the study population. Ensure correct use of the terms sex (when reporting biological factors) and gender (identity, psychosocial or cultural factors). If the study was done involving an exclusive population, for example in only one sex, authors should justify why, except in obvious cases (e.g., prostate cancer). Authors should define how they determined race or ethnicity and justify their relevance.
- Full Title Page
Should be submitted as a separate single Microsoft Word file.
We recommend using the journal’s
template for the full title page(available for download athttps://kjronline.org/index.php?body=Instruction).•
Includes the following items:
Title
Running head, i.e., brief title with 10 or fewer words
Names, ORCID ID (please refer to
orcid.org), affiliations, and addresses of the authors: full author name, not initials, must be provided in the order of first name, middle name (if exists), and last name for all participating authors, e.g. John (first name) Doe (last name).-
Contact information of the corresponding author: name, academic degree, mailing address, phone number, fax number, and e-mail address.
Author contribution
Type of manuscript
Word count of abstract and main text (excluding abstract, references, tables, and figure legends)
Acknowledgments
Funding
Conflicts of interest statement and funding
Data availability statement (applied to original research only)
The information provided on the full title page and the information entered at the manuscript submission website (
http://mc.manuscriptcentral.com/kjr) must be the same.3. Main Document
Original Article and Brief Research Report
The Main Document should be submitted as a separate single Microsoft Word file and includes in the order of blinded title page, structured abstract (word limit of 300 words), keywords (approximately 5 keywords), introduction, materials and methods, results, discussion, references, tables, and figure legends.
On the blinded title page, write only the title and type of the manuscript. Do not include the authors' names, or other details.
Abstract: It should start on a separate page and should be structured including Objective, Materials and Methods, Results, and Conclusion. The Objective and Conclusion need to be consistent with those in the main text and should use the same wording. The Results should present the main outcomes of the study using specific numerical data (e.g., absolute numbers and/or rates) with appropriate indicators of statistical uncertainty, such as 95% confidence intervals or
Pvalues.Pvalues should never be presented alone without the actual data that are being compared. Do not use reference citations in the abstract. Abbreviations should be minimized and, if used, must be defined within the abstract by full terminology followed by abbreviation in parenthesis.•
For all manuscripts reporting data from studies involving human participants or animals, formal review and approval, or formal review and waiver, by an appropriate institutional review board or ethics committee is required and should be described at the start of the materials and methods.
If the study includes reuse/overlap of materials previously published or under consideration for publication elsewhere, clearly state the reuse/overlap in materials and methods.
Other Types
The Main Document should be submitted as a separate single Microsoft Word file and includes in the order of a blinded title page (which includes only the title and the type of the manuscript), an unstructured abstract if required (see the table for further instructions), keywords, body text, references, tables, and figure legends. The body text does not require a structured format. Use section headings appropriately to separate and organize the text except for Letter to the Editor. We recommend having a clear introductory paragraph and a clear summary or conclusion paragraph at the document’s front and the end, respectively.
- References
Start on a separate page in the Main Document, numbering the references consecutively in the order in which they appear in the text.
All references must be cited in the text.
Unpublished data should not be cited in the reference list, but parenthetically in the text, for example: (Smith DJ, personal communication), (Smith DJ, unpublished data).
Journal names should be abbreviated according to the Index Medicus.
All authors are to be listed when six or fewer; when there are seven or more, the first six should be given, followed by “et al.”
Inclusive page numbers, e.g., 111-114, are to be given.
The style and punctuation should follow the format illustrated in the following examples and the
EndNote reference style templateis available for download (https://kjronline.org/index.php?body=Instruction).Journal article
Wu E, Wu K, Daneshjou R, Ouyang D, Ho DE, Zou J. How medical AI devices are evaluated: limitations and recommendations from an analysis of FDA approvals.
Nat Med2021;27:582-584Park C, Kim JH, Kim PH, Kim SY, Gwon DI, Chu HH, et al. Imaging predictors of survival in patients with single small hepatocellular carcinoma treated with transarterial chemoembolization.
Korean J Radiol2021;22:213-224Book
Hastie T, Tibshirani R, Friedman J.
The elements of statistical learning: data mining, inference, and prediction. 2nd ed. New York: Springer, 2009:9-40Chapter in a book
Grady DG, Cummings SR, Huang AJ.
Alternative interventional study designs. In: Browner WS, Newman TB, Cummings SR, Grady DG, Huang AJ, Kanaya AM, et al., eds.Designing clinical research. 5th ed. Philadelphia: Wolters Kluwer, 2023:221-239Web content
U.S. Food and Drug Administration. Good machine learning practice for medical device development: guiding principles [accessed on June 30, 2023]. Available at:
Start on a separate page after References in the Main Document. Tables should be numbered using Arabic numerals. The title of the table should be clearly stated in the form of a sentence or a paragraph.
Tables are to be numbered in the order in which they are cited in the text.
Footnote symbols, in the order in which they should be used, are , †, ‡, §, ||, ¶, *, ††, ‡‡, and so on.
All abbreviations used in a table need to be defined independently (from the text of the article or any other tables or figures) in the table’s footnote.
- Figure Legends
Start on a separate page after Tables in the Main Document. Legends should be numbered in the order in which they are cited, using Arabic numerals.
All abbreviations used in a figure need to be defined independently (from the text of the article or any other tables or figures).
In case of the use of previously published figures, the original source must be revealed in the figure legend.
- Figures
For the initial submission, embed images in the Word file as JPG/JPEG images, with figures immediately following relevant figure legends.
For a revised submission, images should be uploaded as separate JPG/JPEG (high-quality option) or TIF/TIFF files. PNG files are not accepted. Do not embed in the Word file. When saving or converting your images to JPG/JPEG format, please choose the high-quality option. This might be indicated by ‘maximum,’ ‘highest,’ or high values on a numeric scale depending on the specific software program.
All figure parts related to one patient should have the same figure number and use English letters after the numerals to distinguish each figure part, e.g. Fig. 1A, 1B, 1C, and so on. Do not label figure numbers (NO A, B, C, and so on) directly on the figures. Match the figure number with the name of the image file, e.g. Fig_1A.jpg.
Labels/arrows should be of professional quality and touch the edge of the feature being labeled. Do not use equilateral triangles for arrowheads. All labels should be large enough to be visible on printed pages. We may request clean figures without labels/arrows during production.
Remove all names and all other identifiers of the patient, authors, and authors' institutions from the figures.
After cropping to the area of interest, images should be at least 300 dpi in resolution and a minimum of 3 inches to a maximum of 7 inches both in width and height.
Written permission from the prior publisher should be obtained for the use of all previously published illustrations and copies of the permission letter should be submitted.
- Supplement
Supplemental text, tables, and figures (with legends) must be compiled into a single Supplement Word document. All supplemental images must be embedded in the Word file. We do not accept other file formats, such as Excel or PowerPoint, except for supplementary audio and video files, which can be submitted separately.
If the Supplement has references, they have to be standalone in the Supplement. Do not mix or share them with the references in the main document.
Authors must ensure the accuracy of the content and format of the materials included in the Supplement Word file, as it will be published as is, without copy editing, in the form in which it was submitted, if accepted.
SUBMISSION OF MANUSCRIPT AND CHECKLIST
Electronic submission is the only method of submitting manuscripts to
Korean Journal of Radiology. Authors should go to thehttp://mc.manuscriptcentral.com/kjr.•
Submission checklist is as shown in the below box.
□
Cover letter.
All texts files in Microsoft Word format (doc or docx).
Complete Full Title Page as a separate Microsoft Word file: use the journal’s
template for the full title page(available for download athttps://kjronline.org/index.php?body=Instruction).□
Main Document as a separate Microsoft Word file, including in the order of blinded title page, abstract, keywords, body text, references, tables, and figure legends.
Supplement (if present) as a separate Word document instead of adding it to the end of the main document.
Word limit for abstract (if applicable): see the summary table above.
Approximately 5 keywords.
Statement of ethical approval and informed consent at the start of the materials and methods (for manuscripts reporting data from studies involving human participants or animals).
For the initial submission, embed figures in the Word file as JPG/JPEG images, with figures immediately following relevant figure legends. For a revised submission, do not embed figures in the Word file. Instead, upload images as separate JPG/JPEG (high-quality option) or TIF/TIFF files.
Digital figures must be at least 300 dpi and a minimum of 3 inches to a maximum of 7 inches in width and height.
For previously published materials, send written permission to reprint.
Provide copies of any materials for which there is overlap with your manuscript (see REDUNDANT PUBLICATION AND RESEARCH ETHICS).
REVIEW PROCESS AND MANUSCRIPT DECISION
Submitted manuscript will first be evaluated at the editorial office regarding the completeness of the submitted materials before assigning handling editors. Modifications/corrections may be requested to the authors at this stage before starting the peer review.
If an editor is an author, the manuscript is handled by different editor(s). The editor/author is not involved in the editorial evaluation or decision to publish the manuscript.
Submitted manuscripts will generally be reviewed by two peer reviewers, who are experts in the submitted subject matter and make suggestions to the editor(s), as well as by the editor(s).
Korean Journal of Radiologyperforms double-blinded peer review of the submitted manuscripts. Both the peer reviewers and the authors are not revealed to the other.
Authors can monitor the progress of the manuscript throughout the review process at
http://mc.manuscriptcentral.com/kjr.•
Submitted manuscripts will be rendered one of the following decisions:
Accept:The manuscript is accepted for publication.
Minor Revision:A revision needs to be submitted within 30 days of the decision. Otherwise, the manuscript will be treated as a new submission.
Major Revision:A revision needs to be submitted within 60 days of the decision. Otherwise, the manuscript will be treated as a new submission.
Reject: Resubmission allowed:Authors are allowed to resubmit their work. However, it is effective only when they are able to respond to the various reviewer comments and make substantial changes to the study. This type of manuscript is generally not suitable for publication unless the authors conduct further research or collect additional data. The resubmitted manuscript will be treated as a new submission.
Reject: No further consideration:The paper will no longer be considered for publication.
A decision to accept a manuscript is not based solely on the scientific validity and originality of the study content; other factors are considered including the extent and importance of new information in the paper as compared with that in other papers being considered, the Journal’s need to represent a wide range of topics, and the overall suitability for
Korean Journal of Radiology.•
Decision letters usually, but not always, convey all factors considered for a particular decision. Occasionally, the comments to the authors may appear to be inconsistent with the editorial decision, which takes into consideration reviewers’ comments to the editor, as well as the additional factors listed above.
If, as the author(s), you believe that we have rejected your article in error, perhaps because we have misunderstood its scientific content, please send an appeal by e-mail to the editorial office (
[email protected]). However, appeals are ineffective in most cases and are discouraged. Any appeals must be submitted within one month of the manuscript decision.•
Submitted manuscripts can be withdrawn by authors’ request at any time before they are formally accepted for publication. However, any withdrawal after a manuscript has entered “under review” status will not be allowed a resubmission after the withdrawal.
INSTRUCTIONS FOR SUBMISSION OF REVISED MANUSCRIPT
A Major Revision and a Minor Revision should be submitted within 60 days and 30 days, respectively, of the decisions. Otherwise, the manuscript will be treated as a new submission.
Please carefully read and follow the instructions written here and those included in the manuscript decision e-mail.
To start the submission of a revised manuscript, log in at the
http://mc.manuscriptcentral.com/kjr. Click the “Manuscripts with Decisions” queue or “Manuscripts Awaiting Revision” queue in the “My Manuscripts” area. Then, find the submission you wish to start the revision process for and click on the “Create Revision” link for that manuscript. Authors can also click on the revision link in the “Author Resources” area.•
To continue with a revised manuscript that has yet to be submitted, click on the “Revised Manuscripts in Draft” queue in the “My Manuscripts” area. Find the submission you wish to continue with and then click on the “Continue Submission” button.
Please submit a point-by-point response to the editor/ reviewer comments by directly putting it in the box provided in “View and Response to Decision Letter” page and by uploading the same as a Microsoft Word document file (doc/docx) on the “File Upload” page.
Any changes in the authorship should be reported to the editor in the cover letter.
For file uploading, if you have updated a file, please delete the original version and upload the revised file. To designate the order in which your files appear, use the dropdowns in the “order” column on the “File Upload” page.
For a revision, we require both annotated and clean copies of the Main Document. Each should be a separate Microsoft Word document. The annotated copy should have changes tracked using the track changes function in Microsoft Word with marginal memos indicating changes (for example, R2-3 indicates response to comment #3 of Reviewer #2).
The figures for a revised manuscript should be in JPG/JPEG (high-quality option) or TIF/TIFF format.
COPYRIGHT
All articles published in the
Korean Journal of Radiologyare under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. For further details, please click the © Permission button in the upper right corner of the journal’s Publication Instructions for Authors page (https://kjronline.org/index.php?body=Instruction).ARTICLE PROCESSING CHARGE
Authors whose manuscripts are finally accepted for publication in the
Korean Journal of Radiologywill be charged a publication fee of 100 USD, except for invited articles regardless of article type, Uncover This Tech Term, Emerging Rad Dx, and Letter. Editorial decision-making is not influenced by the publication fee or waiver status.
Listen to Authors
2026
Volume 27(7); July 2026
Korean J Radiol. 2026 Jul;27(7):660-669. Published online June 23, 2026.
Korean J Radiol. 2026 Jul;27(7):670-681. Published online June 23, 2026.
Volume 27(6); June 2026
Korean J Radiol. 2026 Jun;27(6):532-542. Published online May 26, 2026.
Korean J Radiol. 2026 Jun;27(6):568-577. Published online May 26, 2026.
Korean J Radiol. 2026 Jun;27(6):578-588. Published online May 26, 2026.
Volume 27(5); May 2026
Korean J Radiol. 2026 May;27(5):419-427. Published online April 24, 2026.
Korean J Radiol. 2026 May;27(5):461-470. Published online April 24, 2026.
Korean J Radiol. 2026 May;27(5):484-494. Published online April 13, 2026.
Volume 27(4); April 2026
Korean J Radiol. 2026 Apr;27(4):305-317. Published online March 3, 2026.
Korean J Radiol. 2026 Apr;27(4):318-331. Published online March 3, 2026.
Volume 27(3); March 2026
Korean J Radiol. 2026 Mar;27(3):214-226. Published online February 23, 2026.
Korean J Radiol. 2026 Mar;27(3):276-288. Published online February 3, 2026.
Volume 27(2); February 2026
Korean J Radiol. 2026 Feb;27(2):97-110. Published online January 26, 2026.
Korean J Radiol. 2026 Feb;27(2):161-173. Published online January 26, 2026.
Korean J Radiol. 2026 Feb;27(2):174-185. Published online January 6, 2026.
Volume 27(1); January 2026
Korean J Radiol. 2026 Jan;27(1):34-47. Published online January 2, 2026.
Korean J Radiol. 2026 Jan;27(1):63-75. Published online January 2, 2026.
2025
Volume 26(12); December 2025
Korean J Radiol. 2025 Dec;26(12):1178-1188. Published online November 6, 2025.
Korean J Radiol. 2025 Dec;26(12):1133-1148. Published online November 6, 2025.
Volume 26(11); November 2025
Korean J Radiol. 2025 Nov;26(11):1100-1108. Published online September 24, 2025.
Korean J Radiol. 2025 Nov;26(11):1085-1099. Published online October 2, 2025.
Volume 26(10); October 2025
Korean J Radiol. 2025 Oct;26(10):924-937. Published online September 11, 2025.
Volume 26(9); September 2025
Korean J Radiol. 2025 Sep;26(9):855-866. Published online August 18, 2025.
Korean J Radiol. 2025 Sep;26(9):832-840. Published online July 31, 2025.
Korean J Radiol. 2025 Sep;26(9):817-831. Published online August 18, 2025.
Volume 26(8); August 2025
Korean J Radiol. 2025 Aug;26(8):782-792. Published online July 4, 2025.
Korean J Radiol. 2025 Aug;26(8):759-770. Published online June 13, 2025.
Volume 26(7); July 2025
Korean J Radiol. 2025 Jul;26(7):704-715. Published online June 13, 2025.
Korean J Radiol. 2025 Jul;26(7):678-687. Published online June 13, 2025.
Volume 26(6); June 2025
Korean J Radiol. 2025 Jun;26(6):581-592. Published online May 14, 2025.
Korean J Radiol. 2025 Jun;26(6):557-568. Published online April 17, 2025.
Volume 26(5); May 2025
Korean J Radiol. 2025 May;26(5):460-470. Published online April 14, 2025.
Korean J Radiol. 2025 May;26(5):485-497. Published online April 14, 2025.
Volume 26(4); April 2025
Korean J Radiol. 2025 Apr;26(4):360-367. Published online March 12, 2025.
Korean J Radiol. 2025 Apr;26(4):333-345. Published online March 12, 2025.
Volume 26(3); March 2025
Korean J Radiol. 2025 Mar;26(3):217-229. Published online February 14, 2025.
Volume 26(2); February 2025
Korean J Radiol. 2025 Feb;26(2):135-145. Published online January 17, 2025.
Korean J Radiol. 2025 Feb;26(2):156-168. Published online January 2, 2025.
Volume 26(1); January 2025
Korean J Radiol. 2025 Jan;26(1):43-53. Published online January 2, 2025.
Korean J Radiol. 2025 Jan;26(1):29-42. Published online January 2, 2025.
2024
Volume 25(12); December 2024
Korean J Radiol. 2024 Dec;25(12):1083-1092. Published online November 8, 2024.
Korean J Radiol. 2024 Dec;25(12):1070-1082. Published online October 29, 2024.
Korean J Radiol. 2024 Dec;25(12):1061-1069. Published online November 3, 2024.
Volume 25(11); November 2024
Korean J Radiol. 2024 Nov;25(11):1003-1010. Published online October 17, 2024.
Korean J Radiol. 2024 Nov;25(11):992-1002. Published online October 4, 2024.
Volume 25(10); October 2024
Korean J Radiol. 2024 Oct;25(10):902-912. Published online September 12, 2024.
Korean J Radiol. 2024 Oct;25(10):876-886. Published online September 12, 2024.
Volume 25(9); September 2024
Korean J Radiol. 2024 Sep;25(9):851-858. Published online August 13, 2024.
Korean J Radiol. 2024 Sep;25(9):798-806. Published online August 21, 2024.
Volume 25(7); July 2024
Korean J Radiol. 2024 Jul;25(7):673-683. Published online June 20, 2024.
Volume 25(6); June 2024
Korean J Radiol. 2024 Jun;25(6):540-549. Published online May 13, 2024.
Volume 25(5); May 2024
Korean J Radiol. 2024 May;25(5):426-437. Published online April 22, 2024.
Korean J Radiol. 2024 May;25(5):481-492. Published online March 20, 2024.
Volume 25(4); April 2024
Korean J Radiol. 2024 Apr;25(4):343-350. Published online February 8, 2024.
Volume 25(3); March 2024
Korean J Radiol. 2024 Mar;25(3):217-219. Published online January 10, 2024.
Korean J Radiol. 2024 Mar;25(3):257-266. Published online February 21, 2024.
Volume 25(1); January 2024
Korean J Radiol. 2024 Jan;25(1):11-23. Published online January 2, 2024.
2023
Volume 24(12); December 2023
Korean J Radiol. 2023 Dec;24(12):1241-1248. Published online November 21, 2023.
Volume 24(11); November 2023
Korean J Radiol. 2023 Nov;24(11):1093-1101. Published online September 14, 2023.
Korean J Radiol. 2023 Nov;24(11):1151-1163. Published online October 19, 2023.
Volume 24(10); October 2023
Korean J Radiol. 2023 Oct;24(10):1028-1037. Published online September 22, 2023.
Volume 24(9); September 2023
Korean J Radiol. 2023 Sep;24(9):890-902. Published online August 10, 2023.
Volume 24(8); August 2023
Korean J Radiol. 2023 Aug;24(8):729-738. Published online July 19, 2023.
Volume 24(7); July 2023
Korean J Radiol. 2023 Jul;24(7):681-689. Published online June 9, 2023.
Volume 24(6); June 2023
Korean J Radiol. 2023 Jun;24(6):529-540. Published online May 23, 2023.
Volume 24(5); May 2023
Korean J Radiol. 2023 May;24(5):384-394. Published online April 19, 2023.
Volume 24(4); April 2023
Korean J Radiol. 2023 Apr;24(4):349-361. Published online March 7, 2023.
Volume 24(3); March 2023
Korean J Radiol. 2023 Mar;24(3):259-270. Published online February 6, 2023.
Volume 24(2); February 2023
Korean J Radiol. 2023 Feb;24(2):155-165. Published online January 18, 2023.
Volume 24(1); January 2023
Korean J Radiol. 2023 Jan;24(1):39-50. Published online January 2, 2023.
2022
Volume 23(12); December 2022
Korean J Radiol. 2022 Dec;23(12):1269-1280. Published online November 14, 2022.
Volume 23(11); November 2022
Korean J Radiol. 2022 Nov;23(11):1055-1066. Published online August 31, 2022.
Korean J Radiol. 2022 Nov;23(11):1078-1088. Published online September 16, 2022.
Volume 23(10); October 2022
Korean J Radiol. 2022 Oct;23(10):939-948. Published online September 5, 2022.
Korean J Radiol. 2022 Oct;23(10):1009-1018. Published online September 13, 2022.
Volume 23(9); September 2022
Korean J Radiol. 2022 Sep;23(9):911-920. Published online Jun 20, 2022.
Volume 23(8); August 2022
Korean J Radiol. 2022 Aug;23(8):821-827. Published online May 27, 2022.
Korean J Radiol. 2022 Aug;23(8):828-834. Published online Jun 20, 2022.
Volume 23(7); July 2022
Korean J Radiol. 2022 Jul;23(7):720-731. Published online April 4, 2022.
Korean J Radiol. 2022 Jul;23(7):742-751. Published online May 27, 2022.
Volume 23(5); May 2022
Korean J Radiol. 2022 May;23(5):555-565. Published online April 18, 2022.
Volume 23(4); April 2022
Korean J Radiol. 2022 Apr;23(4):413-425. Published online January 27, 2022.
Volume 23(3); March 2022
Korean J Radiol. 2022 Mar;23(3):322-332. Published online January 6, 2022.
Volume 23(2); February 2022
Korean J Radiol. 2022 Feb;23(2):180-188. Published online January 4, 2022.
Volume 23(1); January 2022
Korean J Radiol. 2022 Jan;23(1):30-41. Published online September 13, 2021.
2021
Volume 22(12); December 2021
Korean J Radiol. 2021 Dec;22(12):1974-1984. Published online September 24, 2021.
Volume 22(11); November 2021
Korean J Radiol. 2021 Nov;22(11):1764-1776. Published online July 26, 2021.
Korean J Radiol. 2021 Nov;22(11):1875-1885. Published online July 1, 2021.
Volume 22(10); October 2021
Korean J Radiol. 2021 Oct;22(10):1658-1670. Published online June 1, 2021.
Volume 22(9); September 2021
Korean J Radiol. 2021 Sep;22(9):1451-1461. Published online May 26, 2021.
Volume 22(8); August 2021
Korean J Radiol. 2021 Aug;22(8):1369-1378. Published online May 4, 2021.
Korean J Radiol. 2021 Aug;22(8):1300-1309. Published online April 23, 2021.
Korean J Radiol. 2021 Aug;22(8):1266-1278. Published online April 23, 2021.
Volume 22(7); July 2021
Korean J Radiol. 2021 Jul;22(7):1213-1224. Published online March 9, 2021.
Korean J Radiol. 2021 Jul;22(7):1152-1162. Published online March 9, 2021.
Korean J Radiol. 2021 Jul;22(7):1054-1065. Published online April 1, 2021.
Volume 22(6); June 2021
Korean J Radiol. 2021 Jun;22(6):983-993. Published online March 9, 2021.
Korean J Radiol. 2021 Jun;22(6):867-879. Published online April 1, 2021.
Volume 22(4); April 2021
Korean J Radiol. 2021 Apr;22(4):559-567. Published online November 26, 2020.
Volume 22(2); February 2021
Korean J Radiol. 2021 Feb;22(2):189-197. Published online November 3, 2020.
Korean J Radiol. 2021 Feb;22(2):168-178. Published online November 3, 2020.
2020
Volume 21(11); November 2020
Korean J Radiol. 2020 Nov;21(11):1265-1272. Published online July 27, 2020.
Volume 21(8); August 2020
Korean J Radiol. 2020 Aug;21(8):955-966. Published online May 29, 2020.
2019
Volume 20(4); April 2019
Korean J Radiol. 2019 Apr;20(4):641-648. Published online Mar 11, 2019.
2018
Volume 19(4); Jul-Aug 2018
Korean J Radiol. 2018 Aug;19(4):597-605. Published online June 14.
Volume 19(3); May-Jun 2018
Korean J Radiol. 2018 May-Jun;19(3):489-497. Published online Apr 06, 2018.
2017
Volume 18(6); Nov-Dec 2017
Korean J Radiol. 2017 Nov-Dec;18(6):888-897. Published online September 21, 2017.
Volume 18(4); Jul-Aug 2017
Korean J Radiol. 2017 Jul-Aug;18(4):655-663. Published online May 19, 2017.
Volume 18(3); May-Jun 2017
Korean J Radiol. 2017 May-Jun;18(3):498-509. Published online April 3, 2017.
Volume 18(2); Mar-Apr 2017
Korean J Radiol. 2017 Mar-Apr;18(2):269-278. Published online February 7, 2017.
Volume 18(1); Jan-Feb 2017
Korean J Radiol. 2017 Jan-Feb;18(1):238-248. Published online January 5, 2017.
2016
Volume 17(6); Nov-Dec 2016
Korean J Radiol. 2016 Nov-Dec;17(6):827-845. Published online October 31, 2016.
Volume 17(5); Sep-Oct 2016
Korean J Radiol. 2016 Sep-Oct;17(5):598-619. Published online August 23, 2016.
Korean J Radiol. 2016 Sep-Oct;17(5):657-663. Published online August 23, 2016.
Volume 17(4); Jul-Aug 2016
Korean J Radiol. 2016 Jul-Aug;17(4):445-462. Published online June 27, 2016.
Volume 17(2); Mar-Apr 2016
Korean J Radiol. 2016 Mar-Apr;17(2):182-197. Published online March 2, 2016.
Korean J Radiol. 2016 Mar-Apr;17(2):218-223. Published online March 2, 2016.
Volume 17(1); Jan-Feb 2016
Korean J Radiol. 2016 Jan-Feb;17(1):47-55. Published online January 6, 2016.
Korean J Radiol. 2016 Jan-Feb;17(1):59-68. Published online January 6, 2016.
Korean J Radiol. 2016 Jan-Feb;17(1):117-126. Published online January 6, 2016.
2015
Volume 16(6); Nov-Dec 2015
Korean J Radiol. 2015 Nov-Dec;16(6):1326-1331. Published online October 26, 2015.
Korean J Radiol. 2015 Nov-Dec;16(6):1341-1348. Published online October 26, 2015.
Volume 16(5); Sep-Oct 2015
Korean J Radiol. 2015 Sep-Oct;16(5):1142-1152. Published online August 21, 2015.
Volume 16(4); Jul-Aug 2015
Korean J Radiol. 2015 Jul-Aug;16(4):783-790. Published online July 1, 2015.
Volume 16(3); May-Jun 2015
Korean J Radiol. 2015 May-Jun;16(3):523-530. Published online May 13, 2015.
Volume 16(2); Mar-Apr 2015
Korean J Radiol. 2015 Mar-Apr;16(2):314-324. Published online February 27, 2015.
Volume 16(1); Jan-Feb 2015
Korean J Radiol. 2015 Jan-Feb;16(1):32-49. Published online January 9, 2015.
Korean J Radiol. 2015 Jan-Feb;16(1):201-205. Published online January 9, 2015.
Published online Mar 03, 2026.
https://doi.org/10.3348/kjr.2025.1178
Diagnostic Performance and Clinical Implications of the “Probable Hepatocellular Carcinoma” Category in the Korean Liver Cancer Association-National Cancer Center Korea Guidelines v2022
1
,
2
3
4
5
6
Abstract
Objective
To evaluate the diagnostic performance of the “probable hepatocellular carcinoma (HCC)” category in the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) v2022 guidelines.
Materials and Methods
This multicenter retrospective study included patients at risk of HCC who underwent gadoxetic acid-enhanced MRI between January 2015 and June 2018; a subgroup of these patients also underwent liver CT. Eligible patients had at least one non-cystic lesion (≥10 mm) with a reference standard. Four radiologists interpreted the images independently and the results were pooled. The performance of “definite HCC” and “probable HCC” together and “probable HCC” alone were compared between v2018 and v2022.
Results
A total of 2,237 patients (1,666 men; mean age, 59 ± 11 years) with 2,445 lesions were included. In v2022, 1.5% (143/9,780) of the lesions were additionally categorized as “probable HCC” by four reviewers on MRI; among these, 104 lesions were not HCCs. Focal nodular hyperplasia (FNH) or FNH-like nodules constituted 90.4% (94/104) of the false positives. When “definite HCC” and “probable HCC” were combined, v2022 showed higher sensitivity (83.7% [5,670/6,776] vs. 83.1% [5,631/6,776]) but lower specificity (77.1% [2,316/3,004] vs. 80.6% [2,420/3,004]) than v2018 (P < 0.001). For “probable HCC” alone, v2022 showed a lower positive predictive value (PPV) than v2018 (64.1% [373/582] vs. 76.1% [334/439], P < 0.001). In v2022, lesions with non-rim arterial-phase hyperenhancement (APHE) showed a lower PPV than those without APHE (42.3% [91/215] vs. 76.8% [282/367], P < 0.001). In the CT subgroup (n = 1,590), 1.6% (99/6,360) of the lesions were reassessed as “probable HCC,” and its PPV was 83.8% (83/99) in v2022 whereas no lesions were classified as “probable HCC” under v2018.
Conclusion
The revised “probable HCC” category in the KLCA-NCC v2022 aligns with updates in the diagnostic flow, demonstrating acceptable performance on MRI and CT. Notably, FNH or FNH-like nodules can be misclassified as “probable HCC” when MRI is used.
INTRODUCTION
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 75%–85% of all primary liver cancers [1]. Uniquely, HCC can be diagnosed on the basis of its characteristic imaging features. A combination of non-rim arterial-phase hyperenhancement (APHE) and non-peripheral portal or delayed washout is universally recognized as a criterion for HCC in various guidelines [2, 3, 4, 5], albeit with some variations. A recent study indicated that radiological diagnosis is more commonly employed than histological diagnosis for HCC in the Asia-Pacific region [6].
In 2022, the Korean Liver Cancer Association-National Cancer Center Korea (KLCA-NCC) released the latest version of its guidelines for managing HCC [5]. Although the criteria for “definite HCC” remained unchanged between v2018 and v2022, this latest version includes several modifications to the diagnostic algorithms, particularly concerning the criteria for “probable HCC.” The revision to the “probable HCC” criteria in KLCA-NCC v2022 aims to enhance risk stratification and guide subsequent management more effectively, aligning with the current clinical practice. In KLCA-NCC v2018, the diagnosis of “probable HCC” required the presence of both ancillary features (AFs) suggesting malignancy and those specific to HCC, regardless of the presence of non-rim APHE [7]. In KLCA-NCC v2022, the criteria for “probable HCC” in nodules with non-rim APHE have been simplified. Currently, only one AF, either malignancy-suggestive or HCC-specific, is required to diagnose “probable HCC” [5]. This change was based on data suggesting that any lesion with APHE has a higher pre-test probability of HCC than lesions without APHE [8]. However, the influence of this revision on diagnostic performance and clinical decision-making has not been fully assessed.
Although “probable HCC” is not a definitive diagnosis, it is crucial to distinguish it from an “indeterminate nodule” because the management strategies for these categories differ significantly. Therefore, the implications of this revision must be thoroughly evaluated and validated. In this study, we aimed to evaluate the diagnostic performance of the “probable HCC” category in the KLCA-NCC v2022 in HCC diagnosis, specifically by comparing its performance with the KLCA-NCC v2018.
MATERIALS AND METHODS
This retrospective study was conducted at 11 tertiary hospitals in South Korea: Seoul National University Hospital (IRB No. H-1809-030-969), Samsung Medical Center (IRB No. 2019-01031-001), Korea University Guro Hospital (IRB No. 2019GR0039), Seoul National University Bundang Hospital (IRB No. B-1901/519-404), Seoul St. Mary’s Hospital (IRB No. KC19RCDI0006), Korea University Anam Hospital (IRB No. 2019AN0036), Severance Hospital (IRB No. 4-2018-1107), Kon-Kuk University Medical Center (IRB No. KUH1140141), Chung-Ang University Hospital (IRB No. 1812-018-16229), Gangnam Severance Hospital (IRB No. 3-2019-0012), and Kyung Hee University Hospital (IRB No. 2019-01-032). The Institutional Review Board of each institution waived the requirement for obtaining informed consent. This work received financial support from Bayer Korea (Seoul, Republic of Korea); however, the authors retained full control over the data and the content submitted for publication at all times.
The MRI and CT datasets analyzed in this study were previously utilized in related analyses [9, 10]; However, the current study specifically focused on the “probable HCC” category of KLCA-NCC in the two versions, which has not been addressed in prior publications. We included consecutive patients who met the following eligibility criteria: 1) HCC treatment-naive patients with chronic hepatitis B, chronic hepatitis C, or liver cirrhosis of any etiology, 2) patients who had undergone gadoxetic acid-enhanced MRI between January 2015 and June 2018, 3) patients with at least one non-cystic focal liver lesion (FLL; ≥10 mm) visible on MRI, and 4) patients for whom a detailed reference standard was available, as described in the following section. Patients who met any of the following conditions were excluded: 1) absence of essential MRI sequences, 2) presence of multiple (≥6) FLLs, which complicated precise radiology-pathology correlation, 3) intervals greater than 3 months between MRI and pathological assessments of malignant FLLs, or 4) use of an inappropriate reference standard, such as indeterminate pathological results. Patient demographic data, including sex, age, underlying liver disease, and Child–Pugh classification, were collected by reviewing electronic medical records.
For all eligible patients with malignant FLLs who underwent MRI, we verified whether a liver CT scan had been performed within 8 weeks of MRI. Patients with available CT scans were included in the subgroup analysis, provided they had not received any treatment between the scans and exhibited no rapid disease progression or regression.
Image Acquisition
MRI was performed using a standard dose of gadoxetic acid (0.025 mmol/kg, Eovist or Primovist, Bayer) at either 1.5T or 3T. The sequences included T2-weighted images (T2WI), heavily T2WI, diffusion-weighted images with at least two b-values ranging from 0 to 1,000 sec/mm2, in-phase and opposed-phase images, and images from the precontrast, arterial, portal, transitional, and hepatobiliary phases. Detailed scan parameters are provided in the Supplement (materials and methods).
CT scans were conducted using multidetector scanners equipped with 4–256 channels, operating at 80–140 kVp, in accordance with the protocols of each institution. Images were captured during the precontrast, arterial, portal venous, and delayed phases. The patients received iodine contrast medium at a dose of 1.5–1.6 mL/kg. Details regarding the scanners are available in Supplement (materials and methods).
Image Analysis
Image review was performed using a commercially available web-based platform (mint Lesion; Mint Medical, Heidelberg, Germany), which allowed remote access from each institution. Electronic case report form and automatic categorization flow were customized by the authors and the vendor. Details of the image analysis are described elsewhere [9]. Briefly, the index tumors (up to three in each patient) were annotated by a fellowship-trained body radiologist (J.M.L., with 25 years of experience in body imaging) (Supplement; materials and methods). Subsequently, four fellowship-trained body radiologists (J.H.Y., J.W.K., S.K., M.Y., with 11, 5, 7, and 9 years of experience in body imaging, respectively) who were blinded to the diagnoses independently reviewed the annotated index tumors in all patients using a web-based platform. The interval between the CT and MRI readings was set at more than 6 months to minimize recall bias. The reviewers evaluated the presence of major and AFs in accordance with Liver Imaging Reporting and Data System (LI-RADS) and the imaging features defined by KLCA. Then, the web-based platform automatically assigned KLCA-NCC v2018 categories on the basis of the reviewers’ assessments of the imaging features in real-time. To determine KLCA-NCC v2022 categories, individual patient data recorded on the platform were exported and retrospectively applied to the v2022 diagnostic algorithm for observations with “indeterminate nodule” category in v2018 [5], since the platform did not support the revised criteria at the time of review.
Reference Standard
All malignant FLLs were histologically confirmed within 90 days after gadoxetic acid-enhanced MRI. Benign FLLs were diagnosed either through histological assessments or by demonstrating characteristic imaging features, along with a stable or decreased size on follow-up imaging over a period of 2 years. The imaging criteria for benign FLLs are described in Supplement (materials and methods).
Statistical Analysis
The performance of KLCA-NCC v2018 and v2022 for diagnosing HCC was estimated and evaluated using a generalized estimating equation (GEE) with a binomial distribution and logit link function [11]. This approach was chosen to account for correlations among multiple observations within the same patients. An independent working correlation structure in the GEE analysis was utilized to analyze the positive predictive value (PPV) and negative predictive value (NPV) [11]. In the analysis of sensitivity and specificity, independent working correlation had a smaller or equal quasi-likelihood information criterion in comparison with a compound symmetry structure. The GEE analysis was performed with an independent working correlation and a robust sandwich variance estimator to produce unbiased standard error estimates, even when the assumed correlation structure was incorrectly specified. Interobserver agreement for the categories “definite HCC” and “probable HCC” was assessed using the Fleiss kappa (<0.2, slight agreement; 0.21–0.4, fair agreement; 0.41–0.6, moderate agreement; 0.61–0.8, substantial agreement; 0.81–1.0, almost perfect agreement) [12, 13].
All statistical analyses were performed using SPSS (ver. 27, IBM Corp., Armonk, NY, USA) and SAS 9.4 (SAS Institute Inc., Cary, NC, USA). We compared the sensitivity, specificity, PPV, and NPV pooled across the four readers between v2018 and v2022 based on the four reviewers’ pooled data and included the reader as a covariate in the GEE model to account for the reader effect. We also reported the false discovery rate (FDR), defined as 1 - PPV, which represented the proportion of non-HCC lesions determined by the reference standard among those categorized as “probable HCC” on imaging [14]. A P-value of less than 0.05 was considered statistically significant.
RESULTS
Patient Characteristics
Among the 42,726 patients who underwent gadoxetic acid-enhanced MRI from January 2015 to June 2018, 2,237 patients (1,666 men, mean age 59 ± 11 years) with 2,445 FLLs (median size, 27.4 mm) met the eligibility criteria and were included in the study (Fig. 1). HCCs accounted for 69.3% (1,694/2,445) of the FLLs. Detailed information is provided in Table 1 and Supplement (results). Of these, 1,455 patients (1,101 men; mean age: 59 ± 12 years) with 1,590 FLLs (median size, 22.6 mm) who had undergone CT were included in a subgroup analysis. In these patients, approximately 72.9% (1,159/1,590) of the FLLs were HCCs, and 33.5% (532/1,590) were small FLLs (<20 mm). The median interval between CT and MRI was 11 days (IQR, 5–21 days).
Study flow. HCC = hepatocellular carcinoma, FLL = focal liver lesion
Patient and lesion characteristics of the study population
Diagnostic Performance of Combined “Definite HCC” and “Probable HCC”
When both “definite HCC” and “probable HCC” were considered to indicate positivity, the overall sensitivity of KLCA-NCC v2022 on MRI was 83.7% (95% confidence interval [CI]: 82.4, 84.9), and the specificity was 77.1% (95% CI: 74.6, 79.4), which were significantly higher and lower, respectively, in comparison with the corresponding values for v2018 (P < 0.001 for both; Table 2). The PPV of “definite HCC and probable HCC” was 89.2% (95% CI: 87.8, 90.4), showing a significant decrease in comparison with the corresponding values for v2018 (P < 0.001; Table 2).
Comparison of the performance of “definite HCC” and “probable HCC” together for diagnosing HCC between KLCA-NCC v2018 and v2022
On CT assessments, the sensitivity, specificity, and PPV were 75.5% (95% CI: 73.4, 77.4), 84.0% (95% CI: 81.0, 86.6), and 92.7% (95% CI: 91.1, 94.0), respectively, demonstrating differences from v2018 that were consistent with those observed on MRI (Table 2).
Subgroup analyses of small FLLs (<20 mm) showed a higher sensitivity and lower specificity for v2022 than for v2018 on both CT and MRI (Supplementary Table 1).
Diagnostic Performance of “Probable HCC” Category
In KLCA-NCC v2022, 143 of 9,780 reader assessments (1.5%) were recategorized from “indeterminate nodule” to “probable HCC” by four reviewers on MRI (Fig. 2). Among the 143 FLLs recategorized as “probable HCC,” 27.3% (39/143) were confirmed as HCC, and 104 were not HCC. The false positives of “probable HCC” according to KLCA-NCC v2022 included focal nodular hyperplasia (FNH) or FNH-like nodules (n = 94), intrahepatic cholangiocarcinoma (CCA, n = 4), hemangioma (n = 2), chronic inflammation with fibrosis (n = 2), high-grade dysplastic nodule (n = 1) and necrotic cirrhotic nodule (n = 1) (Figs. 3, 4). The PPV and FDR were 64.1% (95% CI: 57.6, 70.1) and 35.9% (95% CI: 29.2, 42.4), respectively, demonstrating significant decreases and increases, respectively, in comparison with the corresponding values for v2018 (P < 0.001 for both; Table 3, Supplementary Table 2). In small FLLs (<20 mm), the PPV of “probable HCC” was 49.1% (107/218; 95% CI: 38.9, 59.4) in v2022, which was lower than the PPV of 57.1% (84/147; 95% CI: 45.2, 68.3) in v2018 (P = 0.020).
A 48-year-old man with surgically confirmed HCC. A, B: A 29.5-mm mass in liver segment 2 shows mild-to-moderate T2 hyperintensity (A, arrows), non-rim arterial-phase hyperenhancement (B, arrows). C, D: Non-peripheral portal washout (C) and non-targetoid hepatobiliary phase defect (D) are absent (arrows). According to v2018, the mass is classified as an “indeterminate nodule” while it is “probable HCC” in v2022. HCC = hepatocellular carcinoma
A 70-year-old man with surgically confirmed focal nodular hyperplasia-like nodule. A-D: A 19.1-mm nodule in liver segment 4 shows non-rim arterial-phase hyperenhancement (A, arrows), iso- to subtle hyperintensity in the portal venous phase (B, arrows), and hepatobiliary hyperintensity (C, arrows) with mild T2 hyperintensity (D, arrows). The nodule is classified as “indeterminate nodule” and “probable hepatocellular carcinoma” in v2018 and v2022, respectively.
A 38-year-old woman with chronic hepatitis B. A-D: A 23.2-mm mass in liver segment 5 shows non-rim arterial-phase hyperenhancement (A, arrows), absence of portal washout (B, arrows), and hepatobiliary hyperintensity (C, arrows) with a central scar (C, arrowhead), in addition to mild T2 hyperintensity (D, arrows). The mass is classified as “indeterminate nodule” in v2018 and “probable hepatocellular carcinoma” in v2022. On liver biopsy, the mass was diagnosed as focal nodular hyperplasia.
Comparison of the performance of “probable HCC” alone for diagnosing HCC between KLCA-NCC v2018 and v2022
In the CT assessments, under the KLCA-NCC v2022 criteria, 1.6% (99/6,360) of FLLs were reassessed as “probable HCC” by four readers on CT, and 83.8% (83/99) of these recategorized FLLs were pathologically diagnosed as HCCs (Fig. 5), while 16 FLLs were not HCCs. These lesions were instead intrahepatic CCAs (n = 4), FNH or FNH-like nodules (n = 4), hemangiomas (n = 4), combined HCC-CCA (n = 1), angiomyolipoma (n = 1), eosinophilic abscess (n = 1), or lymphoid hyperplasia (n = 1). No FLLs on CT were classified as “probable HCC” according to the v2018 criteria. On CT, the PPV of “probable HCC” was 83.8% (95% CI: 75.1, 89.9), with an FDR of 16.2% (95% CI: 10.1, 24.9) in v2022 (Table 3, Supplementary Table 2). For small FLLs (<20 mm), the PPV of “probable HCC” was 78.1% (25/32, 95% CI: 60.7, 89.2).
A 70-year-old man with surgically confirmed HCC. A: A 26.7-mm mass shows non-rim arterial-phase hyperenhancement in the arterial phase (arrows) on CT. No portal washout is observed (not shown). B: In the delayed phase, an enhancing capsule (arrowheads) is present, while delayed washout is not observed in comparison with the adjacent liver parenchyma. In v2018, the mass is classified as “indeterminate nodule,” while it is “probable HCC” in v2022. HCC = hepatocellular carcinoma
Performance of “Probable HCC” in Relation to the Presence of APHE
For FLLs with APHE, v2022 showed lower PPV (42.3%, 95% CI: 32.1, 53.3) than v2018 (72.2%, 95% CI: 57.2, 83.5) on MRI (P < 0.001). In v2022, PPV was lower for FLLs with APHE than for FLLs without APHE (76.8%, 95% CI: 69.8, 82.7) (P < 0.001). However, no significant difference was observed between the PPVs with and without APHE in v2018 (P = 0.470) (Table 3). For FLLs with APHE on MRI, the presence of HCC-specific AF increased the PPV in comparison with the PPV for cases without HCC-specific AF: 66.3% (53/80, 95% CI: 51.3, 78.5) vs. 28.1% (38/135, 95% CI: 18.2, 40.9) (P < 0.001). On CT, the PPV of “probable HCC” for FLLs with APHE was 83.8% (95% CI: 75.1, 89.9) in v2022 since all FLLs had APHE and HCC-specific AFs. No FLLs were categorized as “probable HCC” according to v2018 regardless of APHE or HCC-specific AFs.
Proportion of HCCs in the “Indeterminate Nodule” Category
In v2022, the number of “indeterminate nodules” assessed by the four reviewers decreased on both MRI (598 in v2022 vs. 741 in v2018) and CT (1,681 in v2022 vs. 1,780 in v2018). On MRI, the pooled proportion of HCC in “indeterminate nodules” was slightly different between v2022 and v2018: 40.8% (244/598, 95% CI: 34.6, 47.4) in v2022 and 38.2% (283/741, 95% CI: 32.5, 44.3) in v2018 (P = 0.037). On CT, the pooled proportion of HCC in “indeterminate” was 46.2% (777/1,681, 95% CI: 41.9, 50.6) in v2022 and 48.3% (860/1,780, 95% CI: 44.1, 52.5) in v2018 (P < 0.001).
Interobserver Agreement
MRI
The interobserver agreement for “definite HCC” was 0.653 (95% CI: 0.632, 0.674). The interobserver agreement for “probable HCC” was 0.330 (95% CI: 0.277, 0.383) and 0.425 (95% CI: 0.375, 0.476) for KLCA-NCC v2018 and KLCA-NCC v2022, respectively.
CT
The interobserver agreement for “definite HCC” was 0.643 (95% CI: 0.617, 0.669). The interobserver agreement for “probable HCC” was 0.031 (95% CI: 0.001, 0.062) for v2022. For v2018, interobserver agreement was not assessed, since none of the FLLs were categorized as “probable HCC”.
DISCUSSION
The differentiation of “probable HCC” from an “indeterminate nodule” is important, since these classifications determine different management plans ranging from aggressive follow-up to conservative surveillance. Accordingly, the KLCA-NCC updated its HCC management guidelines in 2022, specifically altering the criteria for “probable HCC” [5], according to risk stratification based on the appearance of APHE [8]. In v2022, we observed an increase in sensitivity and decrease in specificity on both MRI and CT when both “definite HCC” and “probable HCC” were considered to indicate positive results. However, for the “probable HCC” category alone, our study revealed that these revisions have produced divergent, modality-dependent effects in comparison with v2018. On MRI, the v2022 revision led to a significant decrease in PPV (64.1% vs. 76.1%). On CT, 99 FLLs were reclassified as “probable HCC” in v2022, showing a PPV of 83.8%, whereas v2018 had no “probable HCC” category. Therefore, we believe that the revised v2022 criteria have a non-negligible impact on diagnostic performance.
The impact of this update has been infrequently studied, but our findings diverge from a previous study reporting insignificant differences in sensitivity (83.3%–83.6%) and specificity (90.8%–92.1%) between the two versions when considering both “definite HCC” and “probable HCC” as test-positive results on MRI [15]. This could be attributed to several factors. First, the prevalence of HCC (77%–78%) in the study population of the previous investigation may have been higher than that in our study population, potentially underestimating the false-positive rates in v2022. Second, the inclusive “definite HCC” diagnostic criteria in the KLCA-NCC guidelines when using gadoxetic acid-enhanced MRI may have led to a low rate of recategorization to “probable HCC.” For non-targetoid and non-hemangioma FLLs, lesions with APHE are classified as “definite HCC” if they exhibit an HBP defect, regardless of AFs [5]. Therefore, only non-targetoid FLLs with APHE but without an HBP defect, and which also display at least one AF indicative of malignancy in general or favoring HCC, would be reclassified from “indeterminate nodule” to “probable HCC” in v2022. A limited number of hepatic observations with non-rim APHE do not meet the “definite HCC” criteria, such as HCCs showing hepatobiliary hyperintensity [5], and the incidence of such atypical HCC is known to be low [16] and may not provide sufficient difference in a small cohort. Supporting this hypothesis, the same previous study reported increased sensitivity when using extracellular contrast-agent MRI (78.3%–85.3%) [15]. This difference aligns with our explanation that extracellular contrast-agent MRI, not utilizing HBP hypointensity as a major feature for “definite HCC,” resulting in less inclusive criteria and consequently a larger pool of lesions subject to recategorization to “probable HCC” under the v2022 criteria. Additionally, the pooling of “definite” and “probable” categories when comparing versions could have masked the impact of the revised criteria due to the large number of “definite HCC” diagnoses in both versions [15]. Our study, which focused specifically on the “probable HCC” category and had a large cohort, was able to detect the differences that were previously unrecognized.
On MRI, the PPV for “probable HCC” was 64.1% in v2022. Although lower than the PPV of 76.1% in v2018, this remains within an acceptable range for a non-definitive category and is similar to reports from other guideline systems [17]. Because “probable HCC” is a probability-based, non-definitive category, the PPV of 64.1% seems to be a reasonable lower boundary of this probability category, especially since the broad criteria for “definite HCC” in KLCA-NCC potentially leaves diagnostically challenging observations in this category. However, a detailed analysis revealed that the potential performance gap between the two versions was driven by a specific pathology in our study. The primary driver of this reduced performance was the misclassification of benign FLLs, with FNH or FNH-like nodules accounting for 90.4% (94/104) of all false positives. This reflects the well-recognized challenge in distinguishing FNH- or FNH-like nodules from HCC. Typically, FNH- or FNH-like nodules exhibit homogeneous non-rim APHE, no portal washout, hyperintensity on HBP images, a central scar on T2WI and HBP images, and isointensity on T2WI and precontrast T1-weighted imaging [18, 19]. However, these nodules can sometimes display mild-to-moderate hyperintensity on T2WI or diffusion restriction [18, 19, 20]. Confounding the issue, 10%–15% of HCCs demonstrate HBP hyperintensity, which is associated with the activation of the β-catenin gene mutation and hepatocyte nuclear factor 4α activation [21]. Our findings indicate the need for caution among radiologists when applying the v2022 criteria for “probable HCC” on MRI, particularly for lesions with APHE that lack HCC-specific AFs. When distinctive features of FNH, such as a central scar, are present, these observations may be classified as “indeterminate” to reduce the FDR. However, the FNH or FNH-like nodules classified as “probable HCC” in this study must have demonstrated at least one AF favoring malignancy. Thus, the clinical challenge lies not in excluding classic FNH presentations, but in determining how to weigh conflicting imaging features suggestive of FNH against AFs favoring malignancy. The current KLCA-NCC v2022 criteria lack guidance to address this issue, and future iterations may benefit from explicitly addressing how to handle FNH or FNH-like nodules with AFs that favor malignancy to ensure consistent categorization across readers. Accordingly, guideline committees should deliberate whether to prioritize sensitivity by maintaining the current approach or allow downgrading in the presence of FNH-suggestive features to reduce false positives.
In contrast to the mixed MRI results, the v2022 revision represents a clear improvement for CT. Under the v2018 criteria, no FLLs were classified as “probable HCC” on CT. With the v2022 criteria, however, 99 FLLs were categorized as “probable HCC” on CT. This disparity is explained by the stringent v2018 criteria, which required AFs suggestive of both malignancy in general and HCC in particular. AFs supporting a general malignancy diagnosis include restricted diffusion, mild-to-moderate T2 hyperintensity, and threshold growth, with the first two AFs detectable only on MRI. Consequently, no observations were classified as “probable HCC” on CT when threshold growth was not evident on v2018. Although threshold growth criteria were not utilized in this cross-sectional study, the frequency of “probable HCC” is presumed to be low in clinical practice because confirming threshold growth also necessitates two cross-sectional imaging sessions within a six-month period. Thus, the v2022 revision appears to enhance the detection of “probable HCC” on CT by including FLLs exhibiting non-rim APHE and AFs that specifically favor HCC. This explains the acceptable PPV (83.8%) of “probable HCC” on CT.
This improvement in the CT performance was highly significant in the context of the overall KLCA-NCC v2022 diagnostic algorithm. The updated guidelines have shifted the diagnostic process, now mandating the assessment of AFs after a single first-line imaging study if features of “definite HCC” are not present [5]. This is a shift from the v2018 workflow, which required an immediate second-line examination to reassess the major features before AFs were considered [7]. In v2018, AFs were assessed in both first- and second-line imaging studies only if no major features are detected during either examination [7, 8]. Thus, no concern was noted if AFs were observed in either the first- or second-line studies. However, in v2022, the assessment of AFs is mandatory to categorize the observation into “probable HCC” or “indeterminate nodule” on first-line examinations when radiological hallmarks are absent. Thus, without this revision, the role of CT would be limited to providing “all-or-none” diagnoses (“definite HCC” or “indeterminate nodule”), compromising its effectiveness within the intended probability-based diagnostic system and potentially contradicting the guideline’s stance that CT and MRI are equally recommended as first-line examinations. Therefore, the revised criteria for “probable HCC” in v2022 are considered appropriate and responsive changes that align with modifications in the diagnostic algorithms.
Despite the successful alignment of the diagnostic flow, the differential performance of MRI and CT warrants further analysis of the underlying mechanisms. The v2022 guidelines were updated on the premise that FLLs with APHE would have a higher probability of being HCCs, thus justifying the relaxed criteria [8]. However, our findings directly challenge this assumption. Notably, no significant difference was observed in the PPV between FLLs with and without APHE in v2018. Further, our data showed that on MRI, the PPV for “probable HCC” was actually lower for FLLs with APHE (42.3%) compared to those without APHE (76.8%) in v2022. This became clearer when the role of HCC-specific AFs was examined. Among FLLs with APHE, those with HCC-specific AFs had a PPV of 66.3%, whereas those without APHE had a PPV of only 28.1%. In contrast, CT demonstrated an acceptable PPV of 83.8%, but notably, all FLLs categorized as “probable HCC” on CT possessed both APHE and HCC-specific AFs. These findings suggest that the presence of HCC-specific AFs, rather than APHE alone, is a reliable predictor of this category. The v2022 criterion’s requirement of only one AF (either malignancy in general or HCC-specific) in the presence of APHE appears too lenient, particularly on MRI, where benign mimickers, such as FNH-like nodules, frequently demonstrate APHE but lack HCC-specific features. To improve the diagnostic performance of this category, strategies for filtering common mimickers and different weightings of AFs and prioritizing HCC-specific AFs over general malignancy features may be warranted in future guidelines.
Beyond the direct performance of the “probable HCC” category, examining how the v2022 revision affected the remaining “indeterminate nodule” category is important. In our cohort, the v2022 revision successfully reduced the number of “indeterminate nodules” through reclassification, and the effect on the proportion of HCCs in the remaining indeterminate nodules was modality-dependent. On MRI, the proportion of HCCs in this category paradoxically increased from 38.2% to 40.8%, likely because the v2022 criteria disproportionately reclassified benign FNH-like nodules out of the “indeterminate nodule” pool and thereby concentrated the relative number of HCCs left behind. Conversely, on CT, the proportion of HCCs decreased slightly from 48.3% to 46.2%, reflecting a more effective risk stratification where high-risk FLLs were successfully moved to the “probable HCC” category. The proportion of HCCs in the KLCA-NCC “indeterminate nodule” category aligns with the findings of a recent meta-analysis that reported HCC proportions of 38% on gadoxetic acid-enhanced MRI and 48% on CT for the LR-3 category, a conceptually comparable “indeterminate” category despite different criteria [17]. This consistency across different classification systems indicates that approximately 40% of the indeterminate lesions represent HCC, regardless of the specific criteria employed. The persistently high proportion of HCCs in this category indicates that “indeterminate” should not be interpreted as “likely benign” and underscores the need for vigilant management such as short-interval follow-up or complementary imaging. Given that only a small subset of nodules was reclassified and approximately 40% of indeterminate nodules remain HCCs, future guidelines may benefit from incorporating additional imaging features or risk factors to achieve more refined risk stratification of this heterogeneous category.
Our data revealed that applying the revised criteria presented challenges in terms of consistency. Interobserver agreement for the “probable HCC” classification was moderate on MRI (κ = 0.425) and poor on CT (κ = 0.031) in v2022, contrasting with the substantial agreement for “definite HCC.” This can be explained by the reported low interobserver agreement in AF assessment [22]. This variability highlights the challenges in consistently applying AFs for “probable HCC” among readers and the potential for heterogeneity in clinical decision-making across institutions. These findings underscore the need for standardized educational initiatives to minimize interpretive variability and ensure consistent implementation of the guidelines.
Our study had several limitations. First, its retrospective design inevitably introduced bias. Second, the PPV and accuracy of “probable HCC” may have appeared higher in our study cohort, which had a higher HCC prevalence, than they would in lower-prevalence populations. The high prevalence of HCC in the study population, although representative of the clinical situation in South Korea, may have exaggerated the sensitivity and accuracy of “probable HCC” in both versions. Third, a direct comparison of the performance of “probable HCC” on CT assessments between v2018 and v2022 was not possible since the v2018 criteria did not categorize any FLLs into this category on CT as we could not assess “threshold growth” due to our cross-sectional study design. In addition, our study only included histologically confirmed malignant FLLs, which may have led to a higher proportion of atypical HCC cases than in the general HCC population. Finally, all MRI scans were performed with gadoxetic acid in tertiary centers; caution is needed when extrapolating the findings to different practice settings and MRI using extracellular contrast agents.
In conclusion, the revised “probable HCC” category in KLCA-NCC v2022 aligns with the updated diagnostic flow and demonstrates acceptable performance on MRI and CT. Our findings indicate that HCC-specific AFs, rather than APHE, drive the diagnostic accuracy in this category. FNH or FNH-like nodules can be misclassified as “probable HCC” when MRI is used. The increased FDR of “probable HCC” on MRI in v2022 and the persistently high proportion of HCCs in the “indeterminate nodule” category highlight a critical area for further refinement in future guideline amendments.
Supplement
The Supplement is available with this article at https://doi.org/10.3348/kjr.2025.1178.
Click here to view.(146K, pdf)
Conflicts of Interest:Jin-Young Choi, a Section Editor, and Jeong Min Lee, an Editorial Board Member of the Korean Journal of Radiology, were not involved in the editorial evaluation or decision to publish this article. The remaining authors have declared no conflicts of interest.
Author Contributions:
- Conceptualization:Jeong Min Lee, Beom Jin Park.
- Data curation:Jeong Min Lee, Young Kon Kim, Chang Hee Lee, Won Chang, Joon-Il Choi, Beom Jin Park, Jin-Young Choi, Hee Sun Park, Eun Sun Lee, Jeong-Sik Yu, Seong Jin Park.
- Formal analysis:Jeong Hee Yoon, Jeong Woo Kim, Seung-seob Kim, Myung-Won You, Myoung-jin Jang.
- Funding acquisition:Jeong Min Lee.
- Investigation:Jeong Min Lee, Beom Jin Park, Jin-Young Choi, Jeong Hee Yoon, Myoung-jin Jang.
- Methodology:Jeong Min Lee, Beom Jin Park, Jin-Young Choi, Jeong Hee Yoon.
- Project administration:Jeong Min Lee.
- Resources:Jeong Min Lee, Young Kon Kim, Chang Hee Lee, Won Chang, Joon-Il Choi, Beom Jin Park, Jin-Young Choi, Hee Sun Park, Eun Sun Lee, Jeong-Sik Yu, Seong Jin Park.
- Software:Jeong Min Lee, Jeong Hee Yoon.
- Supervision:Jeong Min Lee, Beom Jin Park.
- Visualization:Jeong Hee Yoon, Jin-Young Choi.
- Writing—original draft:Jeong Hee Yoon, Jin-Young Choi.
- Writing—review & editing:all authors.
Funding Statement:This work was financially supported by Bayer (Grant No. H-1809-030-969), but the authors had complete control of the data and information submitted for publication at all times.
Availability of Data and Material
Individual patient data will not be publicly shared due to privacy concerns. Data generated or analyzed during the study are available from the corresponding author by request.
Acknowledgments
We appreciate the statistical advice from the Medical Research Collaborating Center (MRCC) at Seoul National University Hospital and Seoul National University College of Medicine. We would like to thank the Advanced Medical Imaging Institute in the Department of Radiology, the Korea University Anam Hospital, and researchers for providing various forms of technical support.
References
European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2018;69:182–236.
Korean Liver Cancer Association (KLCA); National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2022;23:1126–1240.
Sim YK, Chong MC, Gandhi M, Pokharkar YM, Zhu Y, Shi L, et al. Real-world data on the diagnosis, treatment, and management of hepatocellular carcinoma in the Asia-Pacific: the INSIGHT study. Liver Cancer 2023;13:298–313.
Korean Liver Cancer Association (KLCA); National Cancer Center (NCC). 2018 Korean Liver Cancer Association–National Cancer Center Korea Practice guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2019;20:1042–1113.
Yoon JH, Chang W, Kim YK, Lee CH, Kim JW, Park BJ, et al. Comparison of gadoxetic acid-enhanced liver magnetic resonance imaging and contrast-enhanced computed tomography for the noninvasive diagnosis of hepatocellular carcinoma. Liver Cancer 2025;14:638–650.
Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005;37:360–363.
Yoon JK, Lee S, Hwang JA, Lee JE, Kim SS, Kim MJ. Diagnostic performance of the 2022 KLCA-NCC criteria for hepatocellular carcinoma on magnetic resonance imaging with extracellular contrast and hepatobiliary agents: comparison with the 2018 KLCA-NCC criteria. J Liver Cancer 2023;23:157–165.
Publication Types
MeSH Terms
Figures
Tables
ORCID IDs
Funding Information
BayerH-1809-030-969