Diagnostic performance of CT/MRI LI-RADS v2018 in non-cirrhotic hepatitis C virus infection

Area of Science:

• Radiology
• Hepatology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a significant complication of chronic hepatitis C virus (HCV) infection.
• Cirrhosis is a known risk factor for HCC, but its absence does not preclude malignancy.
• Accurate imaging characterization is crucial for timely diagnosis and management of liver lesions in HCV patients.

Purpose of the Study:

• To assess the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) in patients with non-cirrhotic HCV infection.
• To evaluate the accuracy of LI-RADS for identifying hepatocellular carcinoma (HCC) and overall malignancy in this specific patient cohort.

Main Methods:

• Retrospective analysis of 66 liver CT or MRI observations from 43 adult patients with HCV and no cirrhosis (histopathologically confirmed).
• Three radiologists independently assessed imaging using LI-RADS v2018 criteria, blinded to patient outcomes.
• Calculation of positive predictive value, sensitivity, specificity, and accuracy for LI-RADS categories in diagnosing HCC and malignancy, with inter-reader agreement analysis.

Main Results:

• Of 66 observations, 80% were malignant. LI-RADS LR-5 showed high positive predictive value (98-100%) for HCC.
• For LR-5, sensitivity for HCC ranged from 74-90%, specificity from 94-100%, and accuracy from 80-91%.
• The composite of LR-5, LR-M, or LR-TIV demonstrated high accuracy (89-97%) for overall malignancy, with substantial inter-reader agreement for final LI-RADS categories.

Conclusions:

• CT/MRI LI-RADS v2018 criteria are applicable and perform with near-perfect specificity in non-cirrhotic HCV patients.
• LI-RADS effectively categorizes liver lesions, aiding in the diagnosis of HCC and malignancy in this population.
• The findings support the use of LI-RADS for risk stratification and management decisions in HCV patients without cirrhosis.