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Impact of the Liver Imaging Reporting and Data System on Research Studies of Diagnosing Hepatocellular Carcinoma
Yura Ahn1, Sang Hyun Choi2, Jong Keon Jang1
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Objective:
Since its introduction in 2011, the CT/MRI diagnostic Liver Imaging Reporting and Data System (LI-RADS) has been updated in 2014, 2017, and 2018. We evaluated the impact of CT/MRI diagnostic LI-RADS on liver MRI research methodology for the diagnosis of hepatocellular carcinoma (HCC).
Materials And Methods:
The MEDLINE, EMBASE, and Cochrane databases were searched for original articles reporting the diagnostic performance of liver MRI for HCC between 2011 and 2019. The MRI techniques, image analysis methods, and diagnostic criteria for HCC used in each study were investigated. The studies were classified into three groups according to the year of publication (2011-2013, 2014-2016, and 2017-2019). We compared the percentage of studies adopting MRI techniques recommended by LI-RADS, image analysis methods in accordance with the lexicon defined in LI-RADS, and diagnostic criteria endorsed by LI-RADS. We compared the pooled sensitivity and specificity between studies that used the LI-RADS and those that did not.
Results:
This systematic review included 179 studies. The percentages of studies using imaging techniques recommended by LI-RADS were 77.8% for 2011-2013, 85.7% for 2014-2016, and 84.2% for 2017-2019, with no significant difference (p = 0.951). After the introduction of LI-RADS, the percentages of studies following the LI-RADS lexicon were 0.0%, 18.4%, and 56.6% in the respective periods (p < 0.001), while the percentages of studies using the LI-RADS diagnostic imaging criteria were 0.0%, 22.9%, and 60.7%, respectively (p < 0.001). Studies that did not use the LI-RADS and those that used the LI-RADS version 2018 showed no significant difference in sensitivity and specificity (86.3% vs. 77.7%, p = 0.102 and 91.4% vs. 89.9%, p = 0.770, respectively), with some difference in heterogeneity (I² = 94.3% vs. 86.7% in sensitivity and I² = 86.6% vs. 53.2% in specificity).
Conclusion:
LI-RADS imparted significant changes in the image analysis methods and diagnostic criteria used in liver MRI research for the diagnosis of HCC.
Insights
The Liver Imaging Reporting and Data System (LI-RADS) significantly influenced hepatocellular carcinoma (HCC) research methodology. LI-RADS adoption increased the use of standardized lexicon and diagnostic criteria in liver MRI studies.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- The Liver Imaging Reporting and Data System (LI-RADS) was introduced in 2011 to standardize the reporting and data collection of liver imaging findings.
- LI-RADS has undergone several updates, with versions released in 2014, 2017, and 2018.
- Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver, and accurate diagnosis through imaging is crucial.
Purpose of the Study:
- To evaluate the impact of the CT/MRI diagnostic LI-RADS on liver MRI research methodology for HCC diagnosis.
- To assess changes in imaging techniques, image analysis methods, and diagnostic criteria used in HCC research following LI-RADS implementation.
Main Methods:
- A systematic review of original articles published between 2011 and 2019 was conducted using MEDLINE, EMBASE, and Cochrane databases.
- Studies reporting diagnostic performance of liver MRI for HCC were analyzed for MRI techniques, image analysis methods, and diagnostic criteria.
- Studies were categorized into three groups based on publication year to compare adoption rates of LI-RADS recommendations over time.
Main Results:
- While the use of LI-RADS-recommended imaging techniques showed no significant change over time, adherence to the LI-RADS lexicon and diagnostic criteria increased substantially after its introduction (p < 0.001).
- The percentage of studies using LI-RADS lexicon rose from 0.0% (2011-2013) to 56.6% (2017-2019), and diagnostic criteria use increased from 0.0% to 60.7% in the same periods.
- No significant difference in pooled sensitivity and specificity was observed between studies using LI-RADS and those that did not, although heterogeneity varied.
Conclusions:
- The LI-RADS system has demonstrably influenced the methodology of liver MRI research for HCC diagnosis.
- Significant changes were observed in the adoption of standardized image analysis methods and diagnostic criteria aligned with LI-RADS.
- LI-RADS has contributed to greater standardization in HCC imaging research, although its impact on diagnostic performance metrics requires further investigation.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...