Accuracy of the Liver Imaging Reporting and Data System in Computed Tomography and Magnetic Resonance Image Analysis of Hepatocellular Carcinoma or Overall Malignancy—A Systematic Review

Pol, Christian B. van der; Lim, Christopher; Sirlin, Claude B.; McGrath, Trevor A.; Salameh, Jean‐Paul; Bashir, Mustafa R.; Tang, An; Singal, Amit G.; Costa, Andreu F.; Fowler, Kathryn J.; McInnes, Matthew D. F.

doi:10.1053/j.gastro.2018.11.020

Cited by 239 publications

(213 citation statements)

References 38 publications

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“…A recent systematic review reported that the percentages of observations confirmed as HCC and overall malignancy, respectively, were: LR-5, 94% and 97%; LR-4, 74% and 80%; LR-3, 38% and 40%; LR-2, 13% and 14%; LR-TIV, 79% and 92%; and LR-M, 36% and 93%. 29 No malignancies were found in the LR-1 groups. 29 Our results show a similar tendency based on both LI-RADS v2017 and v2018, which is almost consistent with their results.…”

Section: Discussionmentioning

confidence: 89%

“…29 No malignancies were found in the LR-1 groups. 29 Our results show a similar tendency based on both LI-RADS v2017 and v2018, which is almost consistent with their results. However, there were no malignancies discovered in the LR-2 group based on LI-RADS v2017 or v2018 in our patients; the reason of this difference may be due to patient selection bias.…”

Section: Discussionmentioning

confidence: 89%

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Diagnostic performance of MR for hepatocellular carcinoma based on LI‐RADS v2018, compared with v2017

Ren

Zhao

Yang

et al. 2019

Magnetic Resonance Imaging

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Background The Liver Imaging Reporting and Data System (LI‐RADS) is widely adopted for noninvasive diagnosis of hepatocellular carcinoma (HCC). It's updated to version 2018 recently, with some major changes compared with v2017. However, the diagnostic performance of LI‐RADS v2018 and its difference with v2017 are yet to be validated. Purpose To compare the diagnostic performances of LI‐RADS on MR for diagnosing HCC between v2017 and v2018. Study Type Retrospective. Subjects In all, 181 patients with 217 hepatic observations (146 HCCs, 16 non‐HCC malignancies and 55 benign lesions) with liver MRI and pathological or follow‐up imaging diagnoses. Field Strength/Sequence 1.5 T or 3 T MRI. Dual‐echo T1WI, T2WI, diffusion‐weighted imaging, and a liver acquisition with volume acceleration. AssessmentImages were independently interpreted by three radiologists, and then in consensus for observations with different LR categories, according to LI‐RADS v2017 and v2018, separately. Statistical Tests Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and Youden index. Results When adopting LR‐5 as a predictor of HCC, the sensitivity (80.8% vs. 71.2%), NPV (69.6% vs. 60.7%), and accuracy (83.9% vs. 77.9%) were all increased for LI‐RADS v2018 compared with v2017, with a greater Youden index (0.709 vs. 0.627). However, the diagnostic performances of MRI for diagnosing HCC were not changed while adopting LR‐4/5 as a predictor. The threshold growths of 76% (19/25) observations in v2017 were revised to subthreshold growth in v2018, and 16 LR‐4 observations in v2017 were changed to LR‐5 based on v2018. Data Conclusion The diagnostic performance of LI‐RADS v2018 for diagnosing HCC is superior to v2017, with a greater sensitivity, NPV, and accuracy. The revisions in v2018 mainly affect the categorization when adopting LR‐5 as a predictor of HCC. Level of Evidence: 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:746–755.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Diagnostic performance of MR for hepatocellular carcinoma based on LI‐RADS v2018, compared with v2017

Ren

Zhao

Yang

et al. 2019

Magnetic Resonance Imaging

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“…On systematic review, 95% of LR-5 are HCC, 3% are malignant neoplasms other than HCC, and 3% are nonmalignant. 9 The most common false-positive diagnoses are small intrahepatic cholangiocarcinomas 35,36 and combined hepatocellular cholangiocarcinomas (cHCC-CCA). 37,38 Small iCCA may fail to show the classic targetoid dynamic enhancement pattern to prompt LR-M categorization, instead demonstrating nonrim APHE and nonperipheral washout, which may lead to LR-5 category assignment ( Fig.…”

Section: False-positive Lr-5 Diagnosesmentioning

confidence: 99%

“…In fact, in a systematic review by van der Pol, et al, 36% of reported LR-M observations were HCC (95% CI, 26-48%). 9 While this may seem undesirable, there is emerging evidence that HCC categorized as LR-M due to rim APHE tend to be less differentiated and have worse prognosis than more typical HCCs meeting LR-5 criteria. 40,41 Categorizing such HCCs as LR-M may be beneficial by triggering biopsy and enabling the identification of biologically aggressive histological or molecular features.…”

Section: False-positive Lr-5 Diagnosesmentioning

confidence: 99%

“…5,7,8 A recent meta-analysis found that 0% of LR-1 observations are HCC, while 95% of LR-5 observations are HCC. 9 A high positive predictive value for HCC is required for the LR-5 category, as these observations often undergo definitive treatment, including transplantation, without additional diagnostic or histologic confirmation. 3 The diagnostic algorithm is designed to achieve the desired high positive predictive value by requiring the user to consider and reject every other category before applying stringent criteria to assign LR-5.…”

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confidence: 99%

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User and system pitfalls in liver imaging with LI‐RADS

Elsayes

Fowler

Chernyak

et al. 2019

Magnetic Resonance Imaging

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The Liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging, created specifically for patients at risk for hepatocellular carcinoma. Over the past years, LI‐RADS has been progressively implemented into clinical practice, but pitfalls remain related to user error and inherent limitations of the system. User pitfalls include the inappropriate application of LI‐RADS to a low‐risk patient population, incorrect measurement techniques, inaccurate assumptions about LI‐RADS requirements, and improper usage of LI‐RADS terminology and categories. System pitfalls include areas of discordance with the Organ Procurement and Transplantation Network (OPTN) as well as pitfalls related to rare ancillary features. This article reviews common user pitfalls in applying LI‐RADS v2018 and how to avoid preventable errors and also highlights deficiencies of the current version of LI‐RADS and how it might be improved in the future. Level of Evidence:3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2019;50:1673–1686.

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Computed tomography for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease

Nadarević

Giljača

Colli

et al. 2021

Cochrane Database of Systematic Reviews

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Accuracy of the Liver Imaging Reporting and Data System in Computed Tomography and Magnetic Resonance Image Analysis of Hepatocellular Carcinoma or Overall Malignancy—A Systematic Review

Cited by 239 publications

References 38 publications

Diagnostic performance of MR for hepatocellular carcinoma based on LI‐RADS v2018, compared with v2017

Diagnostic performance of MR for hepatocellular carcinoma based on LI‐RADS v2018, compared with v2017

User and system pitfalls in liver imaging with LI‐RADS

Computed tomography for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease

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