CT/MRI and CEUS LI-RADS Major Features Association with Hepatocellular Carcinoma: Individual Patient Data
Christian B van der Pol1, Matthew D F McInnes1, Jean-Paul Salameh1
1From the Dept of Diagnostic Imaging, Juravinski Hosp and Cancer Centre, Hamilton Health Sciences, McMaster Univ, Hamilton, Canada (C.B.v.d.P.); Dept of Radiology and Epidemiology, Univ of Ottawa, Ottawa, Canada (M.D.F.M.); Ottawa Hosp Research Inst Clinical Epidemiology Program, Dept of Medical Imaging, the Ottawa Hosp-Civic Campus, 1053 Carling Ave, Room c-159, Ottawa, ON, Canada K1E 4Y9 (M.D.F.M.); Faculty of Health Sciences, Queen's Univ, Kingston, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hosp Research Inst, Ottawa, Canada (J.P.S.); Centre for Prognosis Research, School of Medicine, Keele Univ, Staffordshire, UK (B.L.); Dept of Radiology, Montefiore Medical Ctr, Bronx, NY (V.C.); Liver Imaging Group, Dept of Radiology, Univ of California San Diego, San Diego, Calif (C.B.S.); Depts of Radiology (M.R.B., B.C.A.) and Medicine (M.R.B.) and Ctr for Advanced Magnetic Resonance Development (M.R.B.), Duke Univ Medical Ctr, Durham, NC; Dept of Radiology, Univ of North Carolina, Chapel Hill, NC (M.R.B., L.M.B.B., K.A.M.); Dept of Radiology, Research Inst of Radiological Science, Yonsei Univ College of Medicine, Seoul, Korea (J.Y.C., M.J.K., Y.Y.K., M.S.P.); Asan Medical Ctr, Univ of Ulsan College of Medicine, Seoul, Korea (S.H.C.); BCLC Group, Liver Unit, Hosp Clínic of Barcelona, Barcelona, Spain (A.F.); IDIBAPS, CIBERehd, Univ of Barcelona, Barcelona, Spain (A.F.); Mallinckrodt Inst of Radiology, Washington Univ School of Medicine, St Louis, Mo (T.J.F.); Div of Internal Medicine, Hepatobiliary and Immunoallergic Diseases (A.G., F.P., E.T.), and Emergency Dept, Medicina d'Urgenza e Pronto Soccorso (L.M.), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dept of Radiology, West China Hosp, Sichuan Univ, Chengdu, China (H.J.); Dept of Radiology (I.J., H.J.K., J.H.K., J.M.L.) and Inst of Radiation Medicine (J.H.K., J.M.L.), Seoul National Univ Hosp, Seoul, Korea; Dept of Radiology, Seoul National Univ College of Medicine, Seoul, Korea (I.J., J.H.K., J.M.L.); Dept of Radiology, Tongji Hosp, Tongji Medical College, Wuhan, China (Z.K.); Huazhong Univ of Science and Technology, Wuhan, China (Z.K.); Dept of Radiology, Weill Cornell Medical Ctr, New York, NY (A.S.K.); Dept of Radiology (G.K., T.Y.) and Advanced Imaging Research Ctr (T.Y.), Univ of Texas Southwestern Medical Ctr, Dallas, Tex; Dept of Radiology and Research Inst of Radiology, Univ of Ulsan College of Medicine, Asan Medical Ctr, Seoul, Korea (S.Y.K.); Dept of Radiology, Dong-A Univ Hosp, Dong-A Univ College of Medicine, Busan, Korea (H.K.); Dept of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); 2nd Radiology Dept, Warsaw Medical Univ, Warsaw, Poland (J.P., G.R.); Inst of Diagnostic and Interventional Radiology, Univ Hosp Zurich, Zurich, Switzerland (C.S.R.); Dept of Radiology, Beaujon Hosp, APHP.Nord, Clichy, France (M.R.); Université de Paris, Paris, France (M.R.); Dept of Radiology, West China Hosp, Sichuan Univ, Chengdu, China (B.S.); Dept of Radiology, Jeonbuk National Univ Medical School and Hosp, Jeonju, Korea (J.S.S.); Dept of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada (A.T.); Dept of Radiology, the Third Affiliated Hosp, Sun Yat-sen Univ, Guangzhou, China (J.W.); Dept of Medical Ultrasonics, Inst of Diagnostic and Interventional Ultrasound, the First Affiliated Hosp of Sun Yat-Sen Univ, Guangzhou, China (W.W.); Depts of Radiology and Medicine, Div of Gastroenterology, Univ of Calgary, Calgary, Canada (S.R.W.); and Foothills Medical Centre, Calgary, Canada (S.R.W.).
Abstract:
Background The Liver Imaging Reporting and Data System (LI-RADS) assigns a risk category for hepatocellular carcinoma (HCC) to imaging observations. Establishing the contributions of major features can inform the diagnostic algorithm. Purpose To perform a systematic review and individual patient data meta-analysis to establish the probability of HCC for each LI-RADS major feature using CT/MRI and contrast-enhanced US (CEUS) LI-RADS in patients at high risk for HCC. Materials and Methods Multiple databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched for studies from January 2014 to September 2019 that evaluated the accuracy of CT, MRI, and CEUS for HCC detection using LI-RADS (CT/MRI LI-RADS, versions 2014, 2017, and 2018; CEUS LI-RADS, versions 2016 and 2017). Data were centralized. Clustering was addressed at the study and patient levels using mixed models. Adjusted odds ratios (ORs) with 95% CIs were determined for each major feature using multivariable stepwise logistic regression. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (PROSPERO protocol: CRD42020164486). Results A total of 32 studies were included, with 1170 CT observations, 3341 MRI observations, and 853 CEUS observations. At multivariable analysis of CT/MRI LI-RADS, all major features were associated with HCC, except threshold growth (OR, 1.6; 95% CI: 0.7, 3.6; P = .07). Nonperipheral washout (OR, 13.2; 95% CI: 9.0, 19.2; P = .01) and nonrim arterial phase hyperenhancement (APHE) (OR, 10.3; 95% CI: 6.7, 15.6; P = .01) had stronger associations with HCC than enhancing capsule (OR, 2.4; 95% CI: 1.7, 3.5; P = .03). On CEUS images, APHE (OR, 7.3; 95% CI: 4.6, 11.5; P = .01), late and mild washout (OR, 4.1; 95% CI: 2.6, 6.6; P = .01), and size of at least 20 mm (OR, 1.6; 95% CI: 1.04, 2.5; P = .04) were associated with HCC. Twenty-five studies (78%) had high risk of bias due to reporting ambiguity or study design flaws. Conclusion Most Liver Imaging Reporting and Data System major features had different independent associations with hepatocellular carcinoma; for CT/MRI, arterial phase hyperenhancement and washout had the strongest associations, whereas threshold growth had no association. © RSNA, 2021 Online supplemental material is available for this article.
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