LI-RADS for CT diagnosis of hepatocellular carcinoma: performance of major and ancillary features

Alhasan, Ayman S.; Cerny, Milena; Olivié, Damien; Billiard, Jean-Sébastien; Bergeron, Catherine; Brown, Kip; Bodson-Clermont, Paule; Castel, Hélène; Turcotte, Simon; Perreault, Pierre; Tang, An

doi:10.1007/s00261-018-1762-2

Cited by 37 publications

(21 citation statements)

References 35 publications

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“…In that study, five of 10 studies had only used pathology as the reference standard, which might have led to verification bias and overestimation of the probability of HCC for LR‐2 5 . In our meta‐analysis using CT/MRI LI‐RADS v2017, only one of six studies that reported the proportion of HCC for LR‐2 used pathology 13 and the other five studies used pathology and CCRS as the reference standard 12,16,18,21,24 . In addition, the definition of the LR‐2 distinctive nodule without malignant features (solid nodule <20 mm distinctive in imaging appearance compared to background nodules and with no major feature of HCC, no feature of LR‐M, and no ancillary feature of malignancy) was clearer in CT/MRI LI‐RADS v2017 4 compared to the LR‐2 cirrhosis‐associated nodule in LI‐RADS v2014, 29 which may refine the LR‐2 category so that it achieves ≤5% probability of HCC.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

Lee

Kim

Roh

et al. 2020

Liver International

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Background & Aims:The liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging in patients at high risk for hepatocellular carcinoma (HCC). We performed a meta-analysis to determine the diagnostic performance of the LR-5 category for HCC and the pooled proportions of HCCs in each LI-RADS category using CT/MRI LI-RADS v2017. Methods:We searched multiple databases for original studies reporting on the diagnostic accuracy of CT/MRI LI-RADS v2017. Random-effects models were used to determine the summary estimates of the diagnostic performance of the LR-5 category and the pooled proportions of HCCs for each LI-RADS category. Risk of bias and concerns regarding applicability were evaluated with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.Results: Fourteen studies (3 prospective studies and 11 retrospective studies) were included in the final analysis, consisting of 2056 patients, 2589 observations, and 1693 HCCs. The pooled per-observation sensitivity was 67% (95% confidence interval [CI], 62%-72%) with specificity of 92% (95% CI, 88%-95%) in the LR-5 category of CT/MRI LI-RADS v2017 for diagnosing HCC. The pooled proportions of HCCs were 0% (95% CI, 0%-0%) for LR-1, 4% (95% CI, 0%-8%) for LR-2, 34% (95% CI, 23%-44%) for LR-3, 67% (95% CI, 53%-81%) for LR-4, and 92% (95% CI, 87%-96%) for LR-5.The proportions of HCCs were significantly different among LI-RADS categories 1-5 (P = .034). Conclusions:The LR-5 category of CT/MRI LI-RADS v2017 shows moderate sensitivity and high specificity for diagnosing HCC. Higher LI-RADS categories contained higher proportions of HCCs. K E Y W O R D S computed tomography, diagnosis, liver neoplasms, magnetic resonance imaging, sensitivity and specificity | 1489 LEE Et aL.

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Section: Discussionmentioning

confidence: 95%

Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

Lee

Kim

Roh

et al. 2020

Liver International

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“…This finding is consistent with an explanation given by LI-RADS v2018 [7] where it states that AFs do not show sufficient specificity for HCC. While there have been previous studies demonstrating that AFs favoring malignancy in general show high specificity for HCC [4,12], readjusted LR-5 after applying these features failed to increase specificity. However, aligned with our expectations, LR-5 readjusted after using AF favoring HCC in particular showed no significant reduction in specificity for HCC while increasing the sensitivity for HCC As for category adjustment after extending APHE to the arterial phase subtraction images, adjusted LR-5 showed increased sensitivity without decreasing the specificity for HCC.…”

Section: Discussionmentioning

confidence: 67%

Gadoxetic acid-enhanced MRI of hepatocellular carcinoma: Diagnostic performance of category-adjusted LR-5 using modified criteria

et al. 2020

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The Liver Imaging Reporting and Data System (LI-RADS) is widely adopted for the noninvasive diagnosis of hepatocellular carcinoma (HCC). Herein, possible strategies to improve the diagnostic performance of LR-5 without reducing specificity for HCC were investigated. This retrospective study included 792 patients who underwent gadoxetate disodium-enhanced magnetic resonance imaging. Hepatic observations were categorized according to LI-RADS v2018 and categories were readjusted by upgrading LR4 to LR5 using ancillary features, arterial phase hyperenhancement (APHE) interpreted with subtraction images, indication of no washout when APHE was absent, extension of washout to the transitional phase, and subthreshold growth as a major feature. Based on LI-RADS v2018, LR-5 showed a sensitivity of 71.9% and a specificity of 97.9% for the diagnosis of HCC. Category-readjusted LR-5 after upgrading LR-4 to LR-5 using ancillary features favoring HCC in particular, subthreshold growth as a major feature, extending washout to transitional phase and APHE interpreted using subtraction images showed significantly increased sensitivity (P<0.001) without decreased specificity (Ps>0.05). The sensitivity of LR-5 can be improved without loss of specificity via category readjustment using AFs favoring HCC in particular, subthreshold growth as a major feature, extending washout to transitional phase and APHE interpreted with subtraction images.

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“…Increase in size of a lesion is a criterion with good specificity for the diagnosis of HCC, threshold growth (evaluated by CT/MRI) having high specificity—between 83–85% [ 48 ]. This means that if one nodule increases in size more than 50% over less than 6 months, it is much more likely to be HCC.…”

Section: Major Featuresmentioning

confidence: 99%

CT/MRI LI-RADS v2018 vs. CEUS LI-RADS v2017—Can Things Be Put Together?

Caraiani

Boca

Bura

et al. 2021

Biology

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Different LI-RADS core documents were released for CEUS and for CT/MRI. Both documents rely on major and ancillary diagnostic criteria. The present paper offers an exhaustive comparison of the two documents focusing on the similarities, but especially on the differences, complementarity, and added value of imaging techniques in classifying liver nodules in cirrhotic livers. The major diagnostic criteria are defined, and the sensitivity and specificity of each major diagnostic criteria are presented according to the literature. The existing differences between techniques in assessing the major diagnostic features can be then exploited in order to ensure a better classification and a better clinical management of liver nodules in cirrhotic livers. Ancillary features depend on the imaging technique used, and their presence can upgrade or downgrade the LI-RADS score of an observation, but only as far as LI-RADS 4. MRI is the imaging technique that provides the greatest number of ancillary features, whereas CEUS has fewer ancillary features than other imaging techniques. In the final part of the manuscript, some recommendations are made by the authors in order to guidephysicians as to when adding another imaging technique can be helpful in managing liver nodules in cirrhotic livers.

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LI-RADS for CT diagnosis of hepatocellular carcinoma: performance of major and ancillary features

Abstract: On CT, LR-5 category has near-perfect specificity for the diagnosis of HCC and ancillary features modifies the final category in few observations.

Cited by 37 publications

References 35 publications

Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

Gadoxetic acid-enhanced MRI of hepatocellular carcinoma: Diagnostic performance of category-adjusted LR-5 using modified criteria

CT/MRI LI-RADS v2018 vs. CEUS LI-RADS v2017—Can Things Be Put Together?

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