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LI-RADS Major Features on MRI for Diagnosing Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jaeseung Shin1, Sunyoung Lee1, Ja Kyung Yoon1
1Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
The reported diagnostic performance for hepatocellular carcinoma (HCC) of each major imaging feature on MRI using standardized definitions of the Liver Imaging Reporting and Data System (LI-RADS) is variable. It is important to know the actual performance of each LI-RADS major imaging feature for imaging diagnosis of HCC and determine the sources of heterogeneity between the reported results.
Purpose:
To systematically determine the performance of each major imaging feature of LI-RADS for diagnosing HCC using either extracellular contrast agent-enhanced MRI (ECA-MRI) or gadoxetate disodium-enhanced MRI (EOB-MRI).
Study Type:
Systematic review and meta-analysis.
Subjects:
Sixteen original articles with 3542 lesions.
Field Strength:
A 1.5 T and 3.0 T.
Assessment:
Data extraction was independently performed by two reviewers who identified and reviewed original articles reporting the diagnostic performance of each LI-RADS major imaging feature-arterial phase hyperenhancement (APHE), observation size, washout appearance, enhancing "capsule," and threshold growth-using MRI. Study characteristics, study population characteristics, MRI characteristics, contrast agent, LI-RADS version, reference standards, and study outcomes were extracted from included studies. Risk of bias and concerns regarding applicability were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Statistical Tests:
Bivariate random-effects models were used to obtain summary estimates of the diagnostic performance of each LI-RADS major imaging feature. Hierarchical summary receiver operating characteristic curves were plotted. Meta-regression analyses were performed to explore potential sources of heterogeneity.
Results:
The pooled per-observation sensitivities and specificities for diagnosing HCC were 85% (95% confidence interval [CI] = 78%-89%) and 57% (95% CI = 44%-70%) for arterial phase hyperenhancement (APHE), 77% (95% CI = 72%-82%), and 74% (95% CI = 63%-83%) for washout appearance, and 52% (95% CI = 41%-64%) and 90% (95% CI = 85%-94%) for enhancing "capsule," respectively.
Data Conclusions:
Among the LI-RADS major features, the sensitivity was the highest for APHE and the specificity was the highest for enhancing "capsule" in the diagnosis of HCC.
Evidence Level:
3 TECHNICAL EFFICACY: Stage 2.
