Adherence to LI-RADS and EASL high-risk population criteria: A systematic review

Abstract

Background and Aims: The Liver Imaging Reporting and Data System (LI-RADS) and European Association for the Study of the Liver (EASL) diagnostic criteria for noninvasive diagnosis of HCC can only be applied to patients at a high risk of HCC. This systematic review assesses adherence to the LI-RADS and EASL high-risk population criteria in published studies. Approach and Results: PubMed was searched for original research, published between January 2012 and December 2021, reporting LI-RADS and EASL diagnostic criteria on contrast-enhanced ultrasound, CT, or MRI. The algorithm version, publication year, risk status, and etiologies of chronic liver disease were recorded for each study. Adherence to high-risk population criteria was evaluated as optimal (unequivocal adherence), suboptimal (equivocal), or inadequate (clear violation). A total of 219 original studies were included, with 215 that used the LI-RADS criteria, 4 EASL only, and 15 that evaluated both LI-RADS and EASL criteria. Optimal, suboptimal, or inadequate adherence to high-risk population criteria was observed in 111/215 (51.6%), 86/215 (40.0%), and 18/215 (8.4%) LI-RADS and 6/19 (31.6%), 5/19 (26.3%), and 8/19 (42.1%) EASL studies (p < 0.001) regardless of the imaging modality. Adherence to high-risk population criteria significantly improved according to the CT/MRI LI-RADS versions (optimal in v2018 in 64.5% of studies; v2017, 45.8%; v2014, 24.4%; v2013.1, 33.3%; p < 0.001) and the publication year (2020–2021, 62.5%; 2018–2019, 33.9%; 2014–2017, 39.3% of all LI-RADS studies; p = 0.002). No significant differences in adherence to high-risk population criteria were observed in the versions of contrast-enhanced ultrasound LI-RADS (p = 0.388) or EASL (p = 0.293). Conclusion: Adherence to high-risk population criteria was optimal or suboptimal in about 90% and 60% of LI-RADS and EASL studies, respectively.

A Post-International Gastrointestinal Cancers’ Conference (IGICC) Position Statements

“…It is pertinent to define vascular invasion since the tumor’s imaging features in the vein might differ from those of parenchymal tumors. 20 , 21 …”

“…It is pertinent to define vascular invasion since the tumor's imaging features in the vein might differ from those of parenchymal tumors. 20,21 The imaging criteria for liver nodules is primarily intended for patients at high risk of developing HCC, such as those with liver cirrhosis, chronic hepatitis B, HCV and current or previous history of HCC. The criteria system may not be suitable for use in the general population or patients with chronic liver disease, excluding those with chronic hepatitis B who have not developed cirrhosis.…”

A personalized approach for tumour biopsy in hepatocellular carcinoma

“…As a preliminary statement, we want to stress that a non-invasive diagnostic system such as the LI-RADS can only be objectively assessed if properly applied. [4] , [5] The authors claim that they included only patients at high risk according to the LI-RADS, which is good, but they indicate that histologically F3 fibrosis was observed in 32 patients, which is not considered as high risk per se , except in patients with HBV or a history of HCC. 5 Also, proper adherence to the system terminology ( e.g ., “arterial phase hyperenhancement” and not “hypervascularization at the arterial phase”, “ancillary features” and not “minor features”) is encouraged.…”

The international quest for the imaging diagnosis of liver cancer

“…The systematic review by Cannella et al assessed adherence to a high-risk population criteria for the imaging diagnosis of HCC, specifically focusing on the Liver Imaging Reporting and Data System (LI-RADS) and the European Association for the Study of the Liver (EASL) definitions in published research studies 1. The accuracy of diagnostic imaging tests, such as CT, MRI, and contrast-enhanced ultrasound, is affected by the pretest probability of HCC 2.…”

“…The systematic review by Cannella et al assessed adherence to a high-risk population criteria for the imaging diagnosis of HCC, specifically focusing on the Liver Imaging Reporting and Data System (LI-RADS) and the European Association for the Study of the Liver (EASL) definitions in published research studies. [1] The accuracy of diagnostic imaging tests, such as CT, MRI, and contrast-enhanced ultrasound, is affected by the pretest probability of HCC. [2] Thus, to minimize the probability of a false-positive diagnosis of lesions that mimic HCC on imaging studies, the imaging criteria for noninvasive diagnosis of HCC are only applicable to patients with a high pretest probability of having HCC.…”