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Diagnostic Performance of LI-RADS Version 2018 for Evaluation of Pediatric Hepatocellular Carcinoma
Geetika Khanna1, Govind B Chavhan1, Gary R Schooler1
1From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.).
Insights
The Liver Imaging Reporting and Data System (LI-RADS) showed moderate sensitivity but low specificity in diagnosing pediatric hepatocellular carcinoma (HCC). This is because key criteria for adult HCC were less frequent in children.
Area of Science:
- Radiology
- Pediatric Oncology
- Medical Imaging
Background:
- The Liver Imaging Reporting and Data System (LI-RADS) is standard for adult hepatocellular carcinoma (HCC) evaluation.
- Pediatric HCC diagnosis lacks standardized imaging criteria.
Purpose of the Study:
- To assess the diagnostic performance of LI-RADS version 2018 for pediatric HCC.
- To compare LI-RADS criteria frequency in pediatric HCC versus adults.
Main Methods:
- Retrospective multi-institution review of pediatric HCC (≤18 years) dynamic CT/MRI scans (2009-2019).
- Comparison with an equal number of other enhancing hepatic lesions.
- Independent radiologist assessment using LI-RADS 2018 criteria.
- Pathologic examination or >1 year follow-up as the reference standard.
Main Results:
- 116 children evaluated (58 HCC, 58 controls).
- Low frequencies of major LI-RADS criteria (e.g., nonrim arterial phase hyperenhancement, washout) observed in pediatric HCC.
- LI-RADS 2018 demonstrated moderate sensitivity (85-88%) and low specificity (54-70%) for malignancy in the overall cohort.
- In the at-risk subgroup, sensitivity was 58-68% and specificity was 56-63%.
Conclusions:
- LI-RADS version 2018 has limitations for diagnosing pediatric HCC.
- Pediatric HCC exhibits distinct imaging features compared to adults, necessitating tailored criteria.
Abstract:
Background The Liver Imaging Reporting and Data System (LI-RADS) has standardized the evaluation of adult but not pediatric hepatocellular carcinoma (HCC). Purpose To evaluate the performance of LI-RADS version 2018 for diagnosis of pediatric HCC. Materials and Methods This multi-institution retrospective study evaluated all available dynamic CT and/or MRI scans of pediatric (≤18 years) HCC from five institutions between July 2009 and April 2019. The control group included an equal number of other enhancing hepatic lesions. Blinded to final diagnosis, three radiologists independently applied LI-RADS version 2018 criteria. The reference standard was pathologic examination or more than 1 year follow-up. Sensitivity and specificity of LI-RADS were computed using a dichotomous classification of LR-1, LR-2, or LR-3 versus LR-4, LR-5, LR-TIV (tumor in vein), or LR-M (probably or definitely malignant but not HCC-specific) for predicting hepatic malignancy in the entire cohort and in patients at risk for HCC. Results The cohort consisted of 116 children: 58 with HCC (mean age, 12 years ± 5; 31 girls) and 58 with other enhancing hepatic masses (mean age, 12 years ± 5; 42 girls). Frequencies of major criteria in classic HCC for the three readers were as follows: nonrim arterial phase hyperenhancement, 49%-62% (19-24 of 39 patients); nonperipheral "washout," 36%-59% (14-23 of 39 patients); and enhancing "capsule," 28%-38% (11-15 of 39 patients). For the full cohort, the sensitivity of LR-4, LR-5, LR-TIV, or LR-M for malignancy among the three readers ranged from 85% (95% CI: 76, 94) to 88% (95% CI: 80, 96); specificity of LR-1, LR-2, or LR-3 for benignity ranged from 54% (95% CI: 40, 68) to 70% (95% CI: 57, 83). In the at-risk subgroup, sensitivity ranged from 58% (95% CI: 36, 80) to 68% (95% CI: 48, 89); specificity ranged from 56% (95% CI: 37, 74) to 63% (95% CI: 45, 81). All lesions categorized as LR-TIV (n = 10-13) were HCCs. Conclusion Liver Imaging Reporting and Data System version 2018 had moderate sensitivity but low specificity for the diagnosis of pediatric hepatocellular carcinoma (HCC), which had low frequencies of the major criteria used for adult HCC diagnosis. © RSNA, 2021 See also the editorial by Paltiel in this issue.
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