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LI-RADS CT and MRI Ancillary Feature Association with Hepatocellular Carcinoma and Malignancy: An Individual
Haben Dawit1, Eric Lam1, Matthew D F McInnes1
1From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (H.D.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (H.D., M.D.F.M., J.P.S.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (E.L.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (M.D.F.M.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (C.B.v.d.P.); Department of Radiology (M.R.B., B.C.A.) and Center for Advanced Magnetic Resonance Development (M.R.B.), Duke University Medical Center, Durham, NC; Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada (J.P.S.); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (B.L.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.H.C., S.Y.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.T.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J., B.S.); Department of Radiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada (S.R.W.); Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea (H.K.); Weill Cornell Medical Center, New York, NY (A.S.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (I.J.); Department of Radiology, Assistance Publique-Hôpitaux de Paris, Nord, Université Paris Cité, CRI UMR 1149, Paris, France (M.R.); Hôpital Beaujon, Clichy, France (M.R.); Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea (J.S.S.); Second Radiology Department, Warsaw Medical University, Warsaw, Poland (J.P., G.R.); Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.K.); and Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Fl, 1276 S Park St, Halifax, NS, Canada B3H 2Y9 (A.F.C.).
Abstract:
Background The independent contribution of each Liver Imaging Reporting and Data System (LI-RADS) CT or MRI ancillary feature (AF) has not been established. Purpose To evaluate the association of LI-RADS AFs with hepatocellular carcinoma (HCC) and malignancy while adjusting for LI-RADS major features through an individual participant data (IPD) meta-analysis. Materials and Methods Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched from January 2014 to January 2022 for studies evaluating the diagnostic accuracy of CT and MRI for HCC using LI-RADS version 2014, 2017, or 2018. Using a one-step approach, IPD across studies were pooled. Adjusted odds ratios (ORs) and 95% CIs were derived from multivariable logistic regression models of each AF combined with major features except threshold growth (excluded because of infrequent reporting). Liver observation clustering was addressed at the study and participant levels through random intercepts. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2. Results Twenty studies comprising 3091 observations (2456 adult participants; mean age, 59 years ± 11 [SD]; 1849 [75.3%] men) were included. In total, 89% (eight of nine) of AFs favoring malignancy were associated with malignancy and/or HCC, 80% (four of five) of AFs favoring HCC were associated with HCC, and 57% (four of seven) of AFs favoring benignity were negatively associated with HCC and/or malignancy. Nonenhancing capsule (OR = 3.50 [95% CI: 1.53, 8.01]) had the strongest association with HCC. Diffusion restriction (OR = 14.45 [95% CI: 9.82, 21.27]) and mild-moderate T2 hyperintensity (OR = 10.18 [95% CI: 7.17, 14.44]) had the strongest association with malignancy. The strongest negative associations with HCC were parallels blood pool enhancement (OR = 0.07 [95% CI: 0.01, 0.49]) and marked T2 hyperintensity (OR = 0.18 [95% CI: 0.07, 0.45]). Seventeen studies (85%) had a high risk of bias. Conclusion Most LI-RADS AFs were independently associated with HCC, malignancy, or benignity as intended when adjusting for major features. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Crivellaro in this issue.
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