{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T07:09:40Z","timestamp":1765177780369},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,1,13]],"date-time":"2017-01-13T00:00:00Z","timestamp":1484265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To identify demographic and imaging features in magnetic resonance imaging (MRI) that are associated with upgrade of Liver Imaging Reporting and Data System (LI\u2010RADS) category 4 (LR\u20104) observations to category 5 (LR\u20105), and to assess their effects on risk of upgrade and time to upgrade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Institutional Review Board approval was obtained for this retrospective, dual\u2010institution Health Insurance Portability and Accountability Act (HIPAA)\u2010compliant study. Radiologists reviewed 1.5T and 3T MRI examinations for 181 LR\u20104 observations in 139 patients, as well as follow\u2010up computed tomography (CT) and MRI examinations and treatment. A stepwise multivariate Cox proportional hazards model analysis was performed to identify predictive risk factors for upgrade to LR\u20105, including patient demographics and LI\u2010RADS imaging features. Overall cumulative risk of upgrade was calculated by using the Kaplan\u2013Meier method. The cumulative risks were compared in the presence\/absence of significant predictive risk factors using the log\u2010rank test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The independent significant predictive risk factors in the 56 LR\u20104 observations that upgraded to LR\u20105 were mild\u2013moderate <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub> hyperintensity (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; hazard ratio\u2009=\u20091.84), growth (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; hazard ratio\u2009=\u20093.71), and hepatitis C infection (<jats:italic>P<\/jats:italic>\u2009=\u20090.02; hazard ratio\u2009=\u20091.69). The overall 6\u2010month cumulative risk of upgrade was 32.7%. The 6\u2010month cumulative risk rate was significantly higher in the presence of <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub> hyperintensity (<jats:italic>P<\/jats:italic>\u2009=\u20090.03; 48.1% vs. 25.4%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For LR\u20104 observations, mild\u2013moderate <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub> hyperintensity, threshold growth, and hepatitis C infection are associated with significantly higher risk of upgrade to LR\u20105. Although mild\u2013moderate <jats:italic>T<\/jats:italic><jats:sub>2<\/jats:sub> hyperintensity was the most useful risk factor for predicting upgrade, actual risk level was only mildly elevated, and the risk of upgrade associated with LR\u20104 observations is similar across subtypes.<\/jats:p><jats:p><jats:bold>Level of Evidence:<\/jats:bold> 3<\/jats:p><jats:p><jats:bold>Technical Efficacy:<\/jats:bold> Stage 5<\/jats:p><jats:p>J. MAGN. RESON. 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