Diagnostic Performance of LI-RADS Version 2018, LI-RADS Version 2017, and OPTN Criteria for Hepatocellular Carcinoma

OBJECTIVE. Liver Imaging Reporting and Data System (LI-RADS) was updated in 2018 (LI-RADS version 2018 [LI-RADSv2018]) to facilitate integration into the American Association for the Study of Liver Diseases 2018 clinical practice guidelines and involved changes in LR-5 categorization and threshold growth definitions. There are also differences between the criteria for LI-RADSv2018 LR-5 category and the criteria for Organ Procurement and Transplantation Network (OPTN) class 5. The objective of our study was to compare the diagnostic performances of LI-RADSv2018, LI-RADS version 2017 (LI-RADSv2017), and OPTN criteria for diagnosing hepatocellular carcinoma (HCC) on MRI. MATERIALS AND METHODS. In this retrospective study, 122 patients with 159 observations were included who met LI-RADS criteria for at risk for HCC and had at least one hepatic observation on MRI performed between January 1, 2015, and January 1, 2018 and who had histopathology results (n = 104) or follow-up imaging (n = 55) as reference standards. Three abdominal radiologists assigned categories independently and in consensus using LI-RADSv2017, LI-RADSv2018, and OPTN criteria. Diagnostic performance was compared among the guidelines with a generalized estimating equation. RESULTS. Fourteen of 159 (8.8%) observations were assigned a different category according to LI-RADSv2018 compared with LI-RADSv2017. Eight of 31 (25.8%) LR-4 observations using v2017 were recategorized as LR-5 using v2018, and all eight were HCC. Six of 31 (19.4%) LR-4 observations based on v2017 were recategorized as LR-3 using v2018, and all six were non-HCCs. Seven of 114 (6.1%) observations not meeting OPTN class 5 criteria were LR-5 using v2018, and all seven were HCC. Sensitivity for HCC of LR-5 and LR-TIV+5 (i.e., LR-TIV [tumor in vein] definitely due to HCC) categories based on v2018 was significantly higher than that based on v2017 (63.9% vs 55.2%, respectively; p = 0.008) without a difference in specificity (97.3% vs 97.3%; p = 1.00). Sensitivity of LR-5 and LR-TIV+5 in LI-RADSv2018 was significantly higher than the sensitivity of class 5 in OPTN criteria (63.9% vs 53.6%; p = 0.004) without a difference in specificity (97.3% vs 97.3%; p = 1.00). Reader agreement was moderate for overall LIRADSv2017 and LI-RADSv2018 categories (κ = 0.504 and 0.561, respectively); substantial for LR-5 and LR-TIV+5 categories as diagnostic of HCC versus other categories for both v2017 and v2018 (κ = 0.758 and 0.802, respectively); and substantial for OPTN class 5 criteria (κ = 0.756). CONCLUSION. The diagnostic performance of LI-RADSv2018 is higher, with higher sensitivity and similar specificity, than the diagnostic performance of LI-RADSv2017 and OPTN criteria for HCC.