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Interreader Agreement for Individual Ancillary Features in LI-RADS CT/MRI Version 2018: A Systematic Review and

Yong Jun Jung1, Sang Hyun Choi1, Subin Heo1

  • 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea.

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Interreader agreement for Liver Imaging Reporting and Data System (LI-RADS) ancillary features (AFs) in CT/MRI v2018 varied. Features favoring malignancy showed higher agreement than those favoring benignity, guiding clinical application.

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Area of Science:

  • Radiology and Medical Imaging
  • Hepatobiliary Malignancies
  • Diagnostic Accuracy

Background:

  • The Liver Imaging Reporting and Data System (LI-RADS) CT/MRI version 2018 (v2018) utilizes ancillary features (AFs) for observation characterization and category assignment.
  • Limited literature exists on the interreader agreement for a comprehensive range of these AFs, necessitating further investigation.

Purpose of the Study:

  • To systematically review and meta-analyze the interreader agreement of individual AFs within LI-RADS CT/MRI v2018.
  • To identify factors contributing to variability in the interpretation of these AFs.

Main Methods:

  • A systematic review and meta-analysis of original research studies published between January 1, 2018, and September 15, 2025, was conducted.
  • Studies reporting interreader agreement for LI-RADS CT/MRI v2018 AFs were searched in MEDLINE, EMBASE, and Cochrane databases.
  • Pooled kappa values for 21 individual AFs were calculated using a DerSimonian-Laird random-effects model with Knapp-Hartung adjustment; metaregression analyzed factors associated with agreement.

Main Results:

  • The analysis included 47 studies with 11,891 patients and 13,695 hepatic observations; three AFs lacked reported data.
  • Pooled kappa values were higher for AFs favoring malignancy (e.g., hepatobiliary-phase hypointensity: 0.84) than those favoring benignity (e.g., enhancement paralleling blood pool: 0.26).
  • Metaregression indicated that a lower proportion of patients with cirrhosis (<80%) and MRI-only modality were associated with greater agreement for certain AFs.

Conclusions:

  • Interreader agreement for LI-RADS CT/MRI v2018 AFs was generally higher for features suggesting malignancy compared to those suggesting benignity.
  • Specific AFs demonstrated variable agreement, with some requiring cautious application in clinical practice, especially in settings associated with reduced agreement.