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CT and MRI Liver Imaging Reporting and Data System Version 2018 for Hepatocellular Carcinoma: A Systematic Review
Sunyoung Lee1, Yeun-Yoon Kim1, Jaeseung Shin1
1Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
The LR-5 category in Liver Imaging Reporting and Data System (LI-RADS) version 2018 shows moderate sensitivity and high specificity for diagnosing hepatocellular carcinoma (HCC). Higher LI-RADS categories correlate with increased likelihood of HCC.
Area of Science:
- Radiology
- Hepatology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Accurate diagnosis of HCC is crucial for effective patient management.
- The Liver Imaging Reporting and Data System (LI-RADS) provides standardized criteria for interpreting liver imaging in at-risk patients.
Purpose of the Study:
- To evaluate the diagnostic performance of the LR-5 category for HCC.
- To determine the pooled proportion of HCC within each LI-RADS category using CT and MRI.
- To assess LI-RADS version 2018 for HCC diagnosis.
Main Methods:
- Systematic literature search of MEDLINE, Embase, and Scopus databases.
- Inclusion of studies reporting diagnostic accuracy of LI-RADS version 2018 for HCC.
- Meta-analysis using random-effects models to estimate pooled sensitivity, specificity, and proportions of HCC.
Main Results:
- Fourteen studies with 2,708 observations (1,841 HCCs) were analyzed.
- Pooled sensitivity for LR-5 was 70% and specificity was 91% for HCC diagnosis.
- Pooled HCC proportions increased with higher categories: LR-3 (31%), LR-4 (64%), LR-5 (95%).
Conclusions:
- LI-RADS version 2018 LR-5 category demonstrates moderate sensitivity and high specificity for HCC.
- Higher LI-RADS categories (LR-3 to LR-5) are associated with progressively higher probabilities of HCC.
- The LI-RADS system effectively stratifies HCC risk in imaging interpretations.
Purpose:
The aim of this study was to determine the diagnostic performance of the LR-5 category for hepatocellular carcinoma (HCC) and the pooled proportion of HCC in each Liver Imaging Reporting and Data System (LI-RADS) category with CT and MRI, using LI-RADS version 2018.
Methods:
The MEDLINE, Embase, and Scopus databases were searched from inception to December 7, 2019, for studies reporting the diagnostic accuracy of LI-RADS version 2018 for HCC. Risk for bias and concerns regarding applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Random-effects models were used to determine the summary estimates of the diagnostic performance of LR-5 and the pooled proportion of HCC for each LI-RADS category.
Results:
Fourteen studies were included in the final analysis, consisting of 2,708 observations with 1,841 HCCs. The pooled per-observation sensitivity and specificity of the LR-5 category for diagnosing HCC were 70% (95% confidence interval [CI], 61%-78%) and 91% (95% CI, 89%-93%), respectively. No HCCs were reported for LR-1 and LR-2. The pooled proportions of HCC were 31% (95% CI, 12%-50%) for LR-3, 64% (95% CI, 47%-80%) for LR-4, 95% (95% CI, 93%-96%) for LR-5, 54% (95% CI, 30%-77%) for LR-TIV, and 33% (95% CI, 21%-46%) for LR-M. The proportions of HCC were significantly different among the LI-RADS categories (P = .022).
Conclusions:
The LR-5 category of LI-RADS version 2018 provided moderate sensitivity and high specificity for diagnosing HCC. Higher LI-RADS categories from LR-3 to LR-5 included greater proportions of HCC.
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