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

Abstract

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.

Liver Imaging Reporting and Data System Version 2018: Impact on Categorization and Hepatocellular Carcinoma Staging

“…This was due to the removal of the antecedent US visibility requirement, which made it easier to categorize 10‐19 mm observations as LR‐5. Our results are similar to those published by Ren et al who demonstrated in an Asian cohort primarily afflicted with chronic hepatitis B and in whom surgical resection is the main curative therapy, that with v2018 there were increased numbers of LR‐5 and LR‐3 observations and a reduction in LR‐4 observations . Our results are the first in a Western cohort, which primarily is afflicted with cirrhosis and in whom transplantation is the only curative option.…”

“…In our study, 1 high‐grade dysplastic nodule met the criteria for LR‐5 based on v2018 and not based on v2017, decreasing the point estimate for the PPV of the LR‐5 category from 100% to 96.4% in the subset of observations with available histology. The results are similar to the 2 retrospective studies using histology as the gold standard, which reported specificity of v2018 LR‐5 criteria to be 89%‐90% . However, the data thus far are available from single‐institution studies.…”

“…In the subset of observations with histologic analysis, the point estimate for sensitivity of LR‐5 category was higher for v2018 (48.2%) compared with v2017 (39.3%), although the sample size was underpowered to demonstrate statistical significance. Similarly, Ren et al demonstrated higher accuracy of LR‐5 using v2018 than v2017 (84% versus 78%, respectively) . This potentially will allow earlier and more efficacious intervention, albeit at the cost of more false‐positive diagnoses .…”

“…In our study, threshold growth definition change had a relatively small impact on category assignment, causing a downgrade in only 2% of LR‐5 and 12% of LR‐4 observations. In the study by Ren et al, threshold growth data were available for only on a small proportion of their total cohort (25 of 181 patients) …”

“…Our results demonstrate that approximately 11% of patients meeting T2 criteria based on LI‐RADS v2018 do not meet eligibility for the HCC exception points (ie, T stage of <2) based on OPTN criteria, and approximately 6% of patients meeting T2 criteria based on OPTN would be placed outside of transplant eligibility (ie, T stage of >2) based on LI‐RADS v2018. Ren et al demonstrated that v2018 LR‐5 criteria had a higher accuracy for the diagnosis of HCC than v2017 criteria (84% versus 78%, respectively) in an Asian population . This suggests that the radiologic staging based on LI‐RADS v2018 may be more accurate than v2017 or OPTN criteria, but this needs to be evaluated prospectively in a North American cohort.…”