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Diagnostic Performance of CT/MRI LI-RADS Version 2018 Major Feature Combinations: Individual Participant Data

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This study analyzed CT/MRI LI-RADS major feature combinations for hepatocellular carcinoma (HCC) risk. Most combinations within categories showed similar positive predictive values (PPVs), supporting current LI-RADS categorization.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) algorithm aids in diagnosing hepatocellular carcinoma (HCC) in high-risk patients using imaging features.
  • Limited data exists on the diagnostic performance of specific LI-RADS major feature combinations.
  • Understanding these combinations is crucial for accurate HCC risk stratification.

Purpose of the Study:

  • To systematically review and perform an individual participant data (IPD) meta-analysis.
  • To establish the positive predictive values (PPVs) of CT/MRI LI-RADS version 2018 major feature combinations.
  • To evaluate these combinations in patients at risk for HCC.

Main Methods:

  • A systematic search of Medline, Embase, Cochrane Central, and Scopus (January 2014 - February 2023).
  • Inclusion of studies reporting HCC percentages for LI-RADS categories in high-risk patients.
  • A one-stage random-effects IPD meta-analysis to calculate PPVs and 95% CIs for major feature combinations. Risk of bias assessed using QUADAS-2.

Main Results:

  • Analysis of 46 studies with 6765 patients and 7500 liver observations.
  • Pooled PPVs: LR-3 (58.28%), LR-4 (80.82%), LR-5 (95.81%).
  • Most LI-RADS major feature combinations within the same category showed similar PPVs, supporting current categorization. Five specific combinations within LR-3, LR-4, and LR-5 demonstrated significantly different PPVs compared to their respective categories.

Conclusions:

  • The majority of CT/MRI LI-RADS major feature combinations exhibit similar PPVs for HCC in high-risk patients.
  • Five specific major feature combinations within LR-3, LR-4, and LR-5 categories warrant further attention due to differing PPVs.
  • Findings support the general validity of current LI-RADS categorization while highlighting areas for potential refinement.