Expanding the Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic population: performance and reliability of LI-RADS for distinguishing hepatocellular carcinoma (HCC) from non-HCC primary liver carcinoma in patients who do not meet strict LI-RADS high-risk criteria

Non-invasive imaging criteria for the diagnosis of hepatocellular carcinoma in non-cirrhotic patients with chronic hepatitis B

“…However, they excluded patients with HBV and did not include liver lesions other than HCC, which could partially explain the high specificity they found. 18 Moreover, the kappa coefficient for agreement was only 0.37, making it difficult to derive definitive conclusions on the performance of imaging criteria from this study.…”

“…Finally, in our series, based on patients referred to a tertiary center, the prevalence of HCC was higher (76%) than could be expected when assessing HBV patients outside of a referral center. The prevalence of LR-5 lesions was 67%, which could be considered also high, but LR-5 prevalence has been reported as low as 15% and as high as 63% or 80% amongst the different studies [18,[23][24][25]. To address this, we provide a detailed J o u r n a l P r e -p r o o f analysis of the potential impact of the prevalence of HCC on the performance of EASL and LI-RADS score.…”

“…patients with liver lesions larger than 2 cm referred to a specialized center underwent a dynamic CT followed by either biopsy or resection [16]. They enrolled 206 patients and divided them into However, they excluded patients with HBV and did not include liver lesions other than HCC, which could partially explain the high specificity they found [18]. Moreover, the kappa coefficient for agreement was only 0.37, making it difficult to drive definitive conclusions on the performance of imaging criteria in this study.…”

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

“…In these populations, the expected PPV of LI-RADS for HCC diagnosis is >95%. 3 Although emerging data suggest that the performance of LI-RADS for the diagnosis of HCC may be equally high in the context of other risk factors for HCC, such as some patients with nonalcoholic fatty liver disease or chronic hepatitis C without cirrhosis, 4 additional scientific evidence is needed to support the application of LI-RADS in these populations, ideally from large prospective clinical studies. Hence, to date, LI-RADS should not be applied when the risk for HCC is low or not well established.…”

“…Currently, the LR-TRA is intended for application in patients after locoregional therapy for HCC, ie, locoablative therapies, transcatheter therapies, and radiation therapies. 4 In the context of radiation therapies (eg, transarterial Y-90 radioembolization, stereotactic body radiation therapy [SBRT]), the assessment of response on CT and MRI is particularly challenging and an area of active research. King et al reported lower inter-reader agreement for LR-TR categories and a higher frequency of TR-Equivocal categorization on early (4–6 weeks) versus late (6–9 months) post-treatment imaging in patients undergoing radioembolization with Y-90.…”