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Individual Participant Data Meta-Analysis of LR-5 in LI-RADS Version 2018 versus Revised LI-RADS for Hepatocellular
Stacy M Goins1, Hanyu Jiang1, Christian B van der Pol1
1From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J., B.S.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada (J.P.S.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (E.L.); Faculty of Medicine at The University of Ottawa, Ottawa, Ontario, Canada (R.G.A.); Departments of Radiology and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada (M.D.F.M.); The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada (M.D.F.M.); Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (A.F.C.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (A.T.); Department of Radiology, College of Medicine, Taibah University, Medina, Saudi Arabia (A.S.A.); Department of Radiology, King Faisal Specialist Hospital and Research Centre, Medina, Saudi Arabia (A.S.A.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland (C.S.R.); Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (C.C.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (M.C.); Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (J.W.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.H.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F., D.R.L.); Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea (I.J.); Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China (Z.K.); Weill Cornell Medical Center, New York, NY (A.S.K.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, South Korea (S.Y.K.); Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Seo-gu, Busan, South Korea (H.K.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy and Université Paris Cité, CRI UMR 1149, Paris, France (M.R.); Second Radiology Department, Warsaw Medical University, Warsaw, Poland (J.P., G.R.); Department of Radiology, Jeonbuk National University Medical School and Hospital, Deokjin-gu, Jeonju, Jeonbuk, South Korea (J.S.S.); Departments of Radiology and Medicine, Duke University Medical Center, 40 Duke Medicine Cir, Durham, NC, 27710 (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.).
Abstract:
Background A simplification of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 (v2018), revised LI-RADS (rLI-RADS), has been proposed for imaging-based diagnosis of hepatocellular carcinoma (HCC). Single-site data suggest that rLI-RADS category 5 (rLR-5) improves sensitivity while maintaining positive predictive value (PPV) of the LI-RADS v2018 category 5 (LR-5), which indicates definite HCC. Purpose To compare the diagnostic performance of LI-RADS v2018 and rLI-RADS in a multicenter data set of patients at risk for HCC by performing an individual patient data meta-analysis. Materials and Methods Multiple databases were searched for studies published from January 2014 to January 2022 that evaluated the diagnostic performance of any version of LI-RADS at CT or MRI for diagnosing HCC. An individual patient data meta-analysis method was applied to observations from the identified studies. Quality Assessment of Diagnostic Accuracy Studies version 2 was applied to determine study risk of bias. Observations were categorized according to major features and either LI-RADS v2018 or rLI-RADS assignments. Diagnostic accuracies of category 5 for each system were calculated using generalized linear mixed models and compared using the likelihood ratio test for sensitivity and the Wald test for PPV. Results Twenty-four studies, including 3840 patients and 4727 observations, were analyzed. The median observation size was 19 mm (IQR, 11-30 mm). rLR-5 showed higher sensitivity compared with LR-5 (70.6% [95% CI: 60.7, 78.9] vs 61.3% [95% CI: 45.9, 74.7]; P < .001), with similar PPV (90.7% vs 92.3%; P = .55). In studies with low risk of bias (n = 4; 1031 observations), rLR-5 also achieved a higher sensitivity than LR-5 (72.3% [95% CI: 63.9, 80.1] vs 66.9% [95% CI: 58.2, 74.5]; P = .02), with similar PPV (83.1% vs 88.7%; P = .47). Conclusion rLR-5 achieved a higher sensitivity for identifying HCC than LR-5 while maintaining a comparable PPV at 90% or more, matching the results presented in the original rLI-RADS study. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sirlin and Chernyak in this issue.
