Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study

Basha, Mohammad Abd Alkhalik; AlAzzazy, Mohamad Zakarya; Ahmed, Ayman; Yousef, Hala Y.; Shehata, S. A.; Sammak, Dena Abd El Aziz El; Fathy, Talaat; Obaya, Ahmed A.; Abdelbary, Eman Hassan

doi:10.1007/s00330-017-5232-y

Cited by 50 publications

(41 citation statements)

References 27 publications

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“…Our study found a high IRR but a lower sensitivity (30%) than anticipated while maintaining a high IRR. The IRR was consistent with previous studies evaluating the interrater agreement of the LI‐RADS diagnostic categories . After changing the cutoff point for detecting disease to include LR‐TR equivocal, sensitivity remained low (44%) with a decrease in specificity and PPV.…”

Section: Discussionsupporting

confidence: 87%

“…For example, a study looking at 240 patients who underwent MRI surveillance for HCC found the LI‐RADS 4 and 5 criteria to be 86% sensitive and 84% specific at detecting HCC. However, only 12% of the cohort used surgical specimens for the diagnoses, whereas the other 88% used core biopsy or radiologic follow‐up as the referent standard for true HCC . Core needle biopsy has a high false‐negative rate due to the inability to distinguish well‐differentiated HCC from cirrhotic liver and the inaccuracy of targeting specimens .…”

Section: Discussionmentioning

confidence: 99%

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Validation of the Liver Imaging Reporting and Data System Treatment Response Criteria After Thermal Ablation for Hepatocellular Carcinoma

Cools¹,

Moon²,

Burke³

et al. 2019

Liver Transpl

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Single hepatocellular carcinoma (HCC) tumors can be successfully eradicated with thermal ablation (TA). We assessed the validity of the Liver Imaging Reporting and Data System Treatment Response (LR-TR) criteria with a retrospective analysis of a single-center database of patients with small HCC tumors (<3 cm in diameter) who underwent both laparoscopic TA and liver transplantation (LT) from 2004 to 2018. Postablation MRIs were assigned LR-TR categories (nonviable, equivocal, and viable) for ablated lesions and Liver Imaging Reporting and Data System (LI-RADS) categories (probable or definite HCC) for untreated lesions. Interpretations were compared with the histopathology of the post-LT explanted liver. There were 45 patients with 81 tumors (59 ablated and 22 untreated; mean size, 2.2 cm), and 23 (39%) of the ablated tumors had viable HCC on histopathology. The sensitivity/specificity of LR-TR categories (nonviable/equivocal versus viable) of ablated tumors was 30%/99%, with a positive predictive value (PPV)/negative predictive value (NPV) of 93%/69%. The sensitivity varied with residual tumor size. The sensitivity/specificity of LI-RADS 4 and 5 diagnostic criteria at detecting new HCC was 65%/94%, respectively, with a PPV/NPV of 85%/84%. The interrater reliability (IRR) was high for LR-TR categories (90% agreement, Cohen's ĸ = 0.75) and for LI-RADS LR-4 and LR-5 diagnostic categories (91% agreement, Cohen's ĸ = 0.80). In patients with HCC <3 cm in diameter, LR-TR criteria after TA had high IRR but low sensitivity, suggesting that the LR-TR categories are precise but inaccurate. The low sensitivity may be secondary to TA's disruption in the local blood flow of the tissue, which could affect the arterial enhancement phase on MRI. Additional investigation and new technologies may be necessary to improve imaging after ablation. Liver Transplantation 26 203-214 2020 AASLD.Liver transplantation (LT) offers patients with cirrhosis and hepatocellular carcinoma (HCC) the best opportunity for longterm cancer-free survival. (1) However, transplantation is only available for patients who meet the Milan criteria. (1-3) Locoregional therapies are used to prevent the tumor burden from progressing while the patient awaits transplantation. (2)(3)(4) Tumor ablation with either radiofrequency ablation (RFA) or microwave ablation (MWA) is recommended as a locoregional bridging therapy by the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) and is particularly effective for single smaller tumors (eg, <3 cm). (3,4) Ablation reduces dropout rates from LT waiting lists by safely preventing tumor progression without causing hepatic decompensation. (5,6) Ablation also has higher rates of complete tumor necrosis compared with alternative strategies to control cOOls et al.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Validation of the Liver Imaging Reporting and Data System Treatment Response Criteria After Thermal Ablation for Hepatocellular Carcinoma

Cools¹,

Moon²,

Burke³

et al. 2019

Liver Transpl

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“…They observed κ-values for venous thrombus, arterial hyperenhancement, washout appearance, and capsule appearance 0.983, 0.621, 0.546, and 0.549 by CT; 0.991, 0.649, 0.674, and 0.742 by MRI, respectively. They found a good level of reproducibility for all LIRADS classes (κ = 0.895 by CT and 0.926 by MRI) [15].…”

Section: Discussionmentioning

confidence: 95%

“…These are the retrospective nature, the relatively small sample size, and the single-centre design. In some multicentric studies higher reproducibility levels for LI-RADS were found [15,22,23]. Also, all MRI examinations were performed with an extracellular gadolinium contrast agent, and we did not evaluate the liver-specific contrast media.…”

Section: Limitationsmentioning

confidence: 99%

How high is the inter-observer reproducibility in the LIRADS reporting system?

et al. 2019

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“…Several studies have demonstrated that the LI-RADS categories are discordant between CT and MRI in about 35%-70% of cases [9] . MRI categorizes more benign lesions as LR-1 compared to CT (25%-30% of those lesions were categorized as LR-3 on CT) [11,12] . When excluding the LR-1 category, MRI-assigned categories are higher compared to the CT-assigned categories (12%-31% of LR-5 observations on MRI were categorized as LR-4, 12% as LR-3, and 15%-29% were not seen on CT) [9,11,12] .…”

Section: Ct/mri Diagnostic Algorithmmentioning

confidence: 99%

Liver imaging reporting and data system and CT/MRI diagnosis of hepatocellular carcinoma

Kanmaniraja¹,

Chernyak²

2020

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The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive and robust system which provides an algorithmic approach to stratify the probability of hepatocellular carcinoma (HCC) for each observation found in patients at risk for HCC. LI-RADS uses a standardized terminology and approach to improve communication between the radiologist and clinicians. LI-RADS version 2018 is noteworthy for its adoption by the American Association for the Study of Liver Disease into its HCC practice guidance. This manuscript provides an overview of the history of LI-RADS, reviews the Computed tomography/magnetic resonance imaging diagnostic algorithm, highlights the key diagnostic criteria for each category, and discusses the advantage of incorporating LI-RADS in clinical practice.

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Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study

Cited by 50 publications

References 27 publications

Validation of the Liver Imaging Reporting and Data System Treatment Response Criteria After Thermal Ablation for Hepatocellular Carcinoma

Validation of the Liver Imaging Reporting and Data System Treatment Response Criteria After Thermal Ablation for Hepatocellular Carcinoma

How high is the inter-observer reproducibility in the LIRADS reporting system?

Liver imaging reporting and data system and CT/MRI diagnosis of hepatocellular carcinoma

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