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Performance of LI-RADS Version 2018 on CT for Determining Eligibility for Liver Transplant According to Milan
Jae Seok Bae1,2, Dong Ho Lee1,2, Sang Min Lee3
1Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Insights
The Liver Imaging Reporting and Data System (LI-RADS) v2018 on CT accurately identifies liver transplant eligibility for hepatocellular carcinoma (HCC) patients. This system aids in determining suitability for liver transplantation based on Milan criteria.
Area of Science:
- Radiology
- Hepatology
- Transplant Surgery
Background:
- Liver Imaging Reporting and Data System (LI-RADS) is primarily studied for hepatocellular carcinoma (HCC) detection.
- Its performance in determining liver transplant (LT) eligibility, especially using CT, requires further investigation.
Purpose of the Study:
- To evaluate the accuracy of LI-RADS version 2018 (v2018) on CT for diagnosing HCC.
- To assess LI-RADS v2018 performance in determining LT eligibility based on the Milan criteria (MC).
Main Methods:
- Retrospective analysis of 136 high-risk HCC patients who underwent pre-LT CT scans.
- Independent review of CTs by two radiologists using LI-RADS v2018.
- Comparison with histopathologic findings of liver explants as the reference standard.
Main Results:
- LI-RADS v2018 demonstrated high positive predictive value (PPV) for HCC detection (Reader 1: 92.8%, Reader 2: 86.5%).
- Accuracy for determining LT eligibility based on MC was high (Reader 1: 92.7%, Reader 2: 85.3%), comparable to OPTN criteria.
- Preoperative LI-RADS evaluation correlated with post-LT overall survival.
Conclusions:
- LI-RADS v2018 on CT is a valuable tool for HCC detection and assessing LT eligibility in high-risk patients.
- The system's accuracy supports its use in clinical practice for pre-transplant evaluations.
- LI-RADS-based eligibility assessment is linked to patient survival outcomes post-transplantation.
Abstract:
BACKGROUND. LI-RADS has been investigated primarily in terms of detection of hepatocellular carcinoma (HCC), with less attention given to its performance, particularly on CT, in determining eligibility for liver transplant (LT). OBJECTIVE. The purpose of our study was to assess the performance of LI-RADS version 2018 (v2018) on CT for the diagnosis of HCC and determination of LT eligibility according to the Milan criteria (MC). METHODS. This retrospective study included 136 patients (110 men, 26 women; mean age, 53.9 ± 8.1 [SD] years) at high-risk for HCC who underwent liver protocol CT within 3 months before LT between January 2010 and December 2018. Two radiologists independently reviewed CT examinations using LI-RADS v2018; Organ Procurement and Transplantation Network (OPTN) classes were constructed from the LI-RADS interpretations. Histopathologic analysis of liver explants served as the reference standard for determining the presence of HCC and LT eligibility based on MC. Diagnostic performance was evaluated. Overall survival (OS) was assessed based on medical record review. RESULTS. Based on histopathologic evaluation of liver explants in the 136 patients, 27 patients had no malignancy, 77 were eligible for LT due to HCC within MC, and 32 were unsuitable for LT (i.e., HCC beyond MC in 16 patients, HCC with macrovascular invasion in 12, non-HCC malignancy in four). LR-5 exhibited per-lesion sensitivity and PPV for HCC of 55.9% and 92.8%, respectively, for reader 1 and 39.8% and 86.5% for reader 2. When considering LR-5 observations to represent HCC in assessing MC, LI-RADS had accuracy for determining LT eligibility of 92.7% for reader 1 and 85.3% for reader 2; OPTN criteria had accuracy for determining LT eligibility of 89.0% for reader 1 and 84.4% for reader 2. Five-year OS for patients within MC versus 5-year OS for patients unsuitable for LT was 92.2 months versus 56.0 months for LI-RADS, 92.6 months versus 47.6 months for OPTN criteria, and 93.3 months versus 55.1 months for histopathologic assessment of liver explants. CONCLUSION. LI-RADS v2018, as evaluated on CT in high-risk patients, shows high PPV for HCC detection and high accuracy for determining LT eligibility based on MC. LT eligibility based on preoperative LI-RADS evaluation is associated with post-LT survival. CLINICAL IMPACT. These findings support the use of LI-RADS on CT in assessing eligibility in patients who are candidates for LT.
