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Lee S, Kim YY, Shin J, Shin H, Sirlin CB, Chernyak V. Performance of LI-RADS category 5 vs combined categories 4 and 5: a systemic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10813-5. [PMID: 38809263 DOI: 10.1007/s00330-024-10813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS, LR) category 5 has high specificity and modest sensitivity for diagnosis of hepatocellular carcinoma (HCC). The purpose of this study was to compare the diagnostic performance of LR-5 vs combined LR-4 and LR-5 (LR-4/5) for HCC diagnosis. METHODS MEDLINE and EMBASE databases through January 03, 2023 were searched for studies reporting the performance of LR-5 and combined LR-4/5 for HCC diagnosis, using CT/MRI LI-RADS version 2014, 2017, or 2018. A bivariate random-effects model was used to calculate the pooled per-observation diagnostic performance. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Sixty-nine studies (15,108 observations, 9928 (65.7%) HCCs) were included. Compared to LR-5, combined LR-4/5 showed significantly higher pooled sensitivity (83.0% (95% CI [80.3-85.8%]) vs 65.7% (95% CI [62.4-69.1%]); p < 0.001), lower pooled specificity (75.0% (95% CI [70.5-79.6%]) vs 91.7% (95% CI [90.2-93.1%]); p < 0.001), lower pooled positive likelihood ratio (3.60 (95% CI [3.06-4.23]) vs 6.18 (95% CI [5.35-7.14]); p < 0.001), and lower pooled negative likelihood ratio (0.22 (95% CI [0.19-0.25]) vs 0.38 (95% CI [0.35-0.41]) vs; p < 0.001). Similar results were seen in all subgroups. CONCLUSIONS Our meta-analysis showed that combining LR-4 and LR-5 would increase sensitivity but decrease specificity, positive likelihood ratio, and negative likelihood ratio. These findings may inform management guidelines and individualized management. CLINICAL RELEVANCE STATEMENT This meta-analysis estimated the magnitude of changes in the sensitivity and specificity of imaging criteria when LI-RADS categories 4 and 5 were combined; these findings can inform management guidelines and individualized management. KEY POINTS There is no single worldwide reporting system for liver imaging, partly due to regional needs. Combining LI-RADS categories 4 and 5 increased sensitivity and decreased specificity and positive and negative likelihood ratios. Changes in the sensitivity and specificity of imaging criteria can inform management guidelines and individualized management.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyejung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lee S, Kim YY, Shin J, Roh YH, Choi JY, Chernyak V, Sirlin CB. Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis. Eur Radiol 2024; 34:1502-1514. [PMID: 37656177 DOI: 10.1007/s00330-023-10134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/24/2023] [Accepted: 07/07/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We performed an updated meta-analysis to determine the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS, LR) 5 category for hepatocellular carcinoma (HCC) using LI-RADS version 2018 (v2018), and to evaluate differences by imaging modalities and type of MRI contrast material. METHODS The MEDLINE and Embase databases were searched for studies reporting the performance of LR-5 using v2018 for diagnosing HCC. A bivariate random-effects model was used to calculate the pooled per-observation sensitivity and specificity. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Forty-eight studies qualified for the meta-analysis, comprising 9031 patients, 10,547 observations, and 7216 HCCs. The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC were 66% (95% CI, 61-70%) and 91% (95% CI, 89-93%), respectively. In the subgroup analysis, MRI with extracellular agent (ECA-MRI) showed significantly higher pooled sensitivity (77% [95% CI, 70-82%]) than CT (66% [95% CI, 58-73%]; p = 0.023) or MRI with gadoxetate (Gx-MRI) (65% [95% CI, 60-70%]; p = 0.001), but there was no significant difference between ECA-MRI and MRI with gadobenate (gadobenate-MRI) (73% [95% CI, 61-82%]; p = 0.495). Pooled specificities were 88% (95% CI, 80-93%) for CT, 92% (95% CI, 86-95%) for ECA-MRI, 93% (95% CI, 91-95%) for Gx-MRI, and 91% (95% CI, 84-95%) for gadobenate-MRI without significant differences (p = 0.084-0.803). CONCLUSIONS LI-RADS v2018 LR-5 provides high specificity for HCC diagnosis regardless of modality or contrast material, while ECA-MRI showed higher sensitivity than CT or Gx-MRI. CLINICAL RELEVANCE STATEMENT Refinement of the criteria for improving sensitivity while maintaining high specificity of LR-5 for HCC diagnosis may be an essential future direction. KEY POINTS • The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC using LI-RADSv2018 were 66% and 91%, respectively. • ECA-MRI showed higher sensitivity than CT (77% vs 66%, p = 0.023) or Gx-MRI (77% vs 65%, p = 0.001). • LI-RADS v2018 LR-5 provides high specificity (88-93%) for HCC diagnosis regardless of modality or contrast material type.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
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Chernyak V. Editorial for "Diagnostic Performance of the 2018 EASL vs. LI-RADS for Hepatocellular Carcinoma Using CT and MRI: A Systematic Review and Meta-Analysis of Comparative Studies". J Magn Reson Imaging 2023; 58:1951-1953. [PMID: 37010126 DOI: 10.1002/jmri.28714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
- Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Sirlin CB, Chernyak V. Are We Ready to Simplify and Improve LI-RADS? Radiology 2023; 309:e233164. [PMID: 38112548 DOI: 10.1148/radiol.233164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (V.C.)
| | - Victoria Chernyak
- From the Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (V.C.)
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Goins SM, Adamo RG, Lam E, Costa AF, van der Pol CB, Salameh JP, Dawit H, McInnes MDF, Bashir MR. Conversion Strategy for LI-RADS Category 5 Observations across Versions 2014, 2017, and 2018. Radiology 2023; 307:e222971. [PMID: 37129488 DOI: 10.1148/radiol.222971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Stacy M Goins
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Robert G Adamo
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Eric Lam
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Andreu F Costa
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Christian B van der Pol
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Jean-Paul Salameh
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Haben Dawit
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Matthew D F McInnes
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
| | - Mustafa R Bashir
- From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (R.G.A.); The Ottawa Hospital Research Insitute, Clinical Epidemiology Program, Ottawa, ON, Canada (E.L., M.D.F.M.); Clinical Epidemiology Program (H.D.), and University of Ottawa Departments of Radiology and Epidemiology (M.D.F.M.), Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (A.F.C.); Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada (A.F.C.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, ON, Canada (J.P.S.); Departments of Radiology and Medicine and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27701 (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.)
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Choi SJ, Choi SH, Kim DW, Kwag M, Byun JH, Won HJ, Shin YM. Value of threshold growth as a major diagnostic feature of hepatocellular carcinoma in LI-RADS. J Hepatol 2023; 78:596-603. [PMID: 36402451 DOI: 10.1016/j.jhep.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS The Liver Reporting and Data System (LI-RADS) version 2018 simplified the definition of threshold growth to '≥50% size increase in a mass in ≤6 months'. However, the diagnostic value of threshold growth for hepatocellular carcinoma (HCC) remained unclear. We evaluated the value of threshold growth, as defined by LI-RADS v2018, in diagnosing HCCs. METHODS Patients who underwent preoperative gadoxetate disodium-enhanced MRI because of the presence of LI-RADS category 2, 3, or 4 rather than category 5 on prior CT/MRI between January 2017 and December 2020 were retrospectively evaluated. Pathologic or clinical diagnoses were used as reference standards. Imaging features were evaluated by three readers according to LI-RADS v2018. The frequency and diagnostic odds ratio of threshold growth were calculated. The diagnostic performance of LI-RADS category 5 was separately evaluated when threshold growth was and was not considered a major feature, and results were compared using generalized estimation equations. Subgroups of patients who underwent CT/MRI during the previous 3-6 months were analyzed. RESULTS Analysis of 340 observations in 243 patients found that the frequency of threshold growth was 18.8% and it gradually increased over time. Threshold growth was significantly associated with HCC (diagnostic odds ratio 5.2; 95% CI 2.1-12.7; p <0.001). Use of threshold growth as a major feature significantly increased sensitivity in both the overall (66.4% vs. 57.3%, p <0.001) and subgroup (73.4% vs. 58.2%, p <0.001) cohorts, but had no effect on specificity in either the overall (97.5% vs. 98.3%, p = 0.319) or subgroup (95.9% vs. 98.0%, p = 0.323) cohorts. CONCLUSION The revised threshold growth of LI-RADS v2018 was significantly associated with HCC. Use of threshold growth as a major diagnostic feature of HCC can improve the sensitivity of LI-RADS v2018. IMPACT AND IMPLICATIONS We found that the revised threshold growth in the Liver Imaging Reporting and Data System version 2018 (LI-RADS v2018) was a significant predictor of hepatocellular carcinoma (HCC). The use of threshold growth as a major imaging feature of HCC significantly increased the sensitivity of LI-RADS v2018, especially small HCCs (≤3.0 cm), compared with its non-use. Because these small HCCs are eligible for curative treatments, the additional detection of small HCCs is clinically meaningful.
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Affiliation(s)
- Se Jin Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
| | - Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Minha Kwag
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
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Zhou Y, Qin Z, Ding J, Zhao L, Chen Y, Wang F, Jing X. Risk Stratification and Distribution of Hepatocellular Carcinomas in CEUS and CT/MRI LI-RADS: A Meta-Analysis. Front Oncol 2022; 12:873913. [PMID: 35425706 PMCID: PMC9001845 DOI: 10.3389/fonc.2022.873913] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background CEUS LI-RADS and CT/MRI LI-RADS have been used in clinical practice for several years. However, there is a lack of evidence-based study to compare the proportion of hepatocellular carcinomas (HCCs) in each category and the distribution of HCCs of these two categorization systems. Purpose The purpose of this study was to compare the proportion of HCCs between corresponding CEUS LI-RADS and CT/MRI LI-RADS categories and the distribution of HCCs and non-HCC malignancies in each category. Methods We searched PubMed, Embase, and Cochrane Central databases from January 2014 to December 2021. The proportion of HCCs and non-HCC malignancies and the corresponding sensitivity, specificity, accuracy, diagnostic odds ratio (DOR), and area under the curve (AUC) of the LR-5 and LR-M categories were determined using a random-effect model. Results A total of 43 studies were included. The proportion of HCCs in CEUS LR-5 was 96%, and that in CECT/MRI LR-5 was 95% (p > 0.05). The proportion of non-HCC malignancy in CEUS LR-M was lower than that of CT/MRI LR-M (35% vs. 58%, p = 0.01). The sensitivity, specificity, and accuracy of CEUS LR-5 for HCCs were 73%, 92%, and 78%, respectively, and of CT/MRI LR-5 for HCCs, 69%, 92%, and 76%, respectively. Conclusion With the upshift of the LI-RADS category, the proportion of HCCs increased. CEUS LR-3 has a lower risk of HCCs than CT/MRI LR-3. CEUS LR-5 and CT/MRI LR-5 have a similar diagnostic performance for HCCs. CEUS LR-M has a higher proportion of HCCs and a lower proportion of non-HCC malignancies compared with CT/MRI LR-M.
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Affiliation(s)
- Yan Zhou
- School of Medicine, Nankai University, Tianjin, China.,Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Zhengyi Qin
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Ying Chen
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Fengmei Wang
- School of Medicine, Nankai University, Tianjin, China.,Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
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What proportion of LI-RADS 5 observations reported in clinical practice do not meet LI-RADS 5 criteria? Eur Radiol 2021; 32:3327-3333. [PMID: 34807269 DOI: 10.1007/s00330-021-08389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Liver Imaging Reporting and Data System (LI-RADS, LR) category 5 (definite hepatocellular carcinoma [HCC]) is assigned based on combinations of major imaging features (MFs): size, arterial-phase hyperenhancement (APHE), washout (WO), enhancing capsule, and threshold growth. The criteria were simplified in v2018 compared to v2017. The goal of this study is to assess the proportion of LR-5 observations reported in clinical practice with LI-RADS v2017 or v2018 that did not meet LR-5 criteria based on reported MFs. METHODS All MR and CT reports using a standardized LI-RADS template between April 2017 and September 2020 were identified retrospectively. For each reported LR-5 observation, size, MFs, and LI-RADS version (v2017 or v2018) were extracted. Reported MFs were used to determine whether LR-5 criteria were met using the applied version of LI-RADS. The data was summarized descriptively. RESULTS Three hundred eight observations in 234 patients (67.6% male, mean age 66.2 years) were reported as LR-5, including 136 (44.2%) with v2017 and 172 (55.8%) with v2018. 8/136 (6%) v2017 LR-5 observations and 6/172 (3%) v2018 LR-5 observations did not meet LR-5 criteria. Of 8 incorrectly categorized v2017 observations, 3 (43%) lacked APHE, 1 (14%) was a 16-mm new observation with APHE only, and 4 (43%) were 10-19 mm with APHE and WO. Of the 6 incorrectly categorized v2018 observations, 5 (83%) lacked APHE and 1 (17%) was < 10 mm. CONCLUSIONS Depending on the LI-RADS version, 3-6% of LR-5 observations reported in clinical practice do not meet LR-5 criteria based on reported MFs. Key Points • Depending on the LI-RADS version, 3-6% of LR-5 observations in clinical practice do not meet LR-5 criteria based on reported major imaging features. • Assigning LR-5 category to observations without nonrim arterial-phase hyperenhancement was the most common error.
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Kim YY, Lee S, Shin J, Son WJ, Shin H, Lee JE, Hwang JA, Chung YE, Choi JY, Park MS. Diagnostic Performance of Liver Imaging Reporting and Data System Version 2017 Versus Version 2018 for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Comparative Studies. J Magn Reson Imaging 2021; 54:1912-1919. [PMID: 33929784 DOI: 10.1002/jmri.27664] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging in patients at risk for hepatocellular carcinoma (HCC). PURPOSE To systematically compare the performance of computed tomography (CT)/MRI LI-RADS category 5 (LR-5) for diagnosing HCC between versions 2017 and 2018. STUDY TYPE Systematic review and meta-analysis. SUBJECTS Six articles with 1181 lesions. FIELD STRENGTH/SEQUENCE 1.5 T and 3.0 T. ASSESSMENT Data extraction was independently performed by two reviewers who identified and reviewed articles comparing the performance of LR-5 for diagnosing HCC between CT/MRI LI-RADS versions 2017 and 2018. Study and patient characteristics, index test characteristics, reference standards, and study outcomes were extracted from included studies. Risk of bias and concerns regarding applicability were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. STATISTICAL TESTS Bivariate random-effects models were used to calculate the pooled per-observation sensitivity and specificity of LR-5 using both versions. The summary receiver operating characteristic curves were plotted. Meta-regression analysis was performed to explore heterogeneity. A P-value <0.05 was considered to be statistically significant for all analyses other than heterogeneity, where the significance threshold was 0.1. RESULTS The pooled per-observation sensitivity of LR-5 for diagnosing HCC did not show statistically significant difference between versions 2017 (60%; 95% confidence interval [CI], 49%-70%) and 2018 (67%; 95% CI, 56%-76%; P = 0.381). The pooled per-observation specificities of LR-5 were not significantly different between versions 2017 (92%; 95% CI, 90%-95%) and 2018 (91%; 95% CI, 88%-93%; P = 0.332). Meta-regression analyses revealed that the most common underlying liver disease (hepatitis B or hepatitis C) was a significant factor contributing to the heterogeneity of sensitivities among studies for both versions. DATA CONCLUSION In this meta-analysis using intraindividual paired comparisons, the pooled sensitivity and pooled specificity of LR-5 were not significantly different between 2017 and 2018 LI-RADS versions. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jeong Son
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyejung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Elmohr M, Elsayes KM, Chernyak V. LI-RADS: Review and updates. Clin Liver Dis (Hoboken) 2021; 17:108-112. [PMID: 33868648 PMCID: PMC8043699 DOI: 10.1002/cld.991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/05/2020] [Accepted: 05/30/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Mohab Elmohr
- Department of RadiologyBaylor College of MedicineHoustonTX
| | - Khaled M. Elsayes
- Division of Abdominal ImagingUniversity of Texas MD Anderson Cancer CenterHoustonTX
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11
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Chen J, Kuang S, Zhang Y, Tang W, Xie S, Zhang L, Rong D, He B, Deng Y, Xiao Y, Shi W, Fowler K, Wang J, Sirlin CB. Increasing the sensitivity of LI-RADS v2018 for diagnosis of small (10-19 mm) HCC on extracellular contrast-enhanced MRI. Abdom Radiol (NY) 2021; 46:1530-1542. [PMID: 33040166 DOI: 10.1007/s00261-020-02790-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate whether the LI-RADS v2018 LR-5 criteria can be modified to increase sensitivity without reducing specificity for diagnosing small (10-19 mm) HCC. METHODS 167 consecutive high-risk patients with 174 small observations reported clinically on extracellular contrast-enhanced MRI from 2014 to 2018 were retrospectively studied. The best available reference standard was applied for each observation. Blinded to the reference standard, two radiologists scored LI-RADS imaging features retrospectively and assigned each observation a LI-RADS category using LI-RADS v2018 and each of four modified LI-RADS versions (mLI-RADS I to IV) with successively more expansive LR-5 criteria. Per-observation sensitivity and specificity of LR-5 for small HCC using each version were assessed. Each modified version was compared to v2018 (McNemar test). RESULTS The 174 observations included 135 HCC, 8 non-HCC malignancies, and 31 benign entities. Using LI-RADS v2018, LR-5 provided 70% (both readers) sensitivity and 95% (both readers) specificity for small HCC. Expanding the LR-5 criteria to include nonrim APHE plus at least one additional major feature (mLI-RADS I) or no APHE plus at least two additional major features (mLI-RADS II) significantly increased sensitivity (reader 1/reader 2: 75%/75% vs. 70%, p = 0.016/0.031; 78%/79% vs. 70%, p = 0.001/0.001) without significantly reducing specificity (reader 1/reader 2: 90%/92% vs. 95%, p = 0.500/1.000 for both). mLI-RADS III and IV further increased sensitivity (reader 1/reader 2: 80%/81% vs. 70%, p < 0.001/< 0.001; 94%/92% vs. 70, p < 0.001/< 0.001) but with trend-level (reader 1/reader 2: 85%/80% vs. 95%, p = 0.125/0.063) or significant (reader 1/reader 2: 64%/62% vs. 95%, p < 0.001/< 0.001) specificity reductions. CONCLUSIONS Expanding the v2018 LR-5 criteria to include nonrim APHE plus at least one additional major feature or no APHE plus at least two additional major features significantly increases sensitivity without significantly reducing specificity for small HCC. Confirmation is warranted in multi-center prospective studies.
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Affiliation(s)
- Jingbiao Chen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Sichi Kuang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Yao Zhang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Wenjie Tang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Sidong Xie
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Linqi Zhang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Dailin Rong
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Bingjun He
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Ying Deng
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Yuanqiang Xiao
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Wenqi Shi
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China
| | - Kathryn Fowler
- Department of Radiology, Liver Imaging Group, University of California, San Diego, CA, 510630, USA
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China.
| | - Claude B Sirlin
- Department of Radiology, Liver Imaging Group, University of California, San Diego, CA, 510630, USA
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Abstract
Patients with early stage hepatocellular carcinoma (HCC) can be cured by liver transplantation. HCC imaging features on CT or MRI are specific enough to allow for definitive diagnosis and treatment without the need of confirmatory biopsy. When applied to the appropriate at-risk population the Liver Imaging Reporting and Data System (LI-RADS) imaging criteria achieve high specificity and positive predictive value for the diagnosis of HCC. The Organ Procurement and Transplantation Network (OPTN) is the United States organization that aims to assure the adequate and fair distribution of livers across candidates. Given the importance of fair organ allocation, OPTN also provides stringent imaging criteria for the diagnosis of HCC aiming to avoid false positive diagnosis. Although most imaging criteria are identical for both systems, discrepancies between LI-RADS and the current OPTN classification system for HCC diagnosis exists. Main differences include, but are not limited to, the binary approach of OPTN to classify lesions as HCC or not, versus the probabilistic algorithmic approach of LI-RADS, technical and interpretation considerations, and the approach towards treated lesions. The purpose of this article is to highlight the similarities and discrepancies between LI-RADS and the current OPTN criteria for HCC diagnosis and the implications that these differences may have on the management of patients who are transplant candidates.
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Body MRI Subspecialty Reinterpretations at a Tertiary Care Center: Discrepancy Rates and Error Types. AJR Am J Roentgenol 2020; 215:1384-1388. [PMID: 33052740 DOI: 10.2214/ajr.20.22797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Radiology departments in tertiary care centers are frequently asked to perform secondary interpretations of imaging studies, particularly when a patient is transferred from a community hospital. Discrepancy rates in radiology vary widely, with low rates reported for preliminary resident reports that are overread by attending radiologists (2-6%) and higher rates (up to 56%) for secondary interpretations. Abdominal and pelvic imaging and cross-sectional imaging have the highest discrepancy rates. The purpose of our study was to determine the discrepancy rate and the most common reasons for discrepancies between abdominal and pelvic MRI reports obtained from outside institutions and secondary interpretations of these reports by a fellowship-trained radiologist at a tertiary care center. MATERIALS AND METHODS. We retrospectively identified 395 secondary MRI reports from January 2015 to December 2018 that were labeled as body MRI examinations at a tertiary care center. Thirty-eight cases were excluded for various reasons, including incorrect categorization or lack of outside report. We reviewed the outside reports, compared them with the secondary interpretations, and categorized the cases as discrepancy or no discrepancy. The discrepancies were subdivided into the most likely reason for the error using previously published categories; these categories were also divided into perceptive and cognitive errors. RESULTS. Of the 357 included cases, 246 (68.9%) had at least one discrepancy. The most common reason for error was faulty reasoning (34.3%), which is a cognitive error characterized by misidentifying an abnormality. Satisfaction of search, which is a perceptive error, was the most common reason for second discrepancies (15.0%). CONCLUSION. Secondary interpretations of body MR images at a tertiary care center identify a high rate of discrepancies, with cognitive error types predominating.
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Diagnostic Performance of LI-RADS Version 2018, LI-RADS Version 2017, and OPTN Criteria for Hepatocellular Carcinoma. AJR Am J Roentgenol 2020; 215:1085-1092. [PMID: 32877248 DOI: 10.2214/ajr.20.22772] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. Liver Imaging Reporting and Data System (LI-RADS) was updated in 2018 (LI-RADS version 2018 [LI-RADSv2018]) to facilitate integration into the American Association for the Study of Liver Diseases 2018 clinical practice guidelines and involved changes in LR-5 categorization and threshold growth definitions. There are also differences between the criteria for LI-RADSv2018 LR-5 category and the criteria for Organ Procurement and Transplantation Network (OPTN) class 5. The objective of our study was to compare the diagnostic performances of LI-RADSv2018, LI-RADS version 2017 (LI-RADSv2017), and OPTN criteria for diagnosing hepatocellular carcinoma (HCC) on MRI. MATERIALS AND METHODS. In this retrospective study, 122 patients with 159 observations were included who met LI-RADS criteria for at risk for HCC and had at least one hepatic observation on MRI performed between January 1, 2015, and January 1, 2018 and who had histopathology results (n = 104) or follow-up imaging (n = 55) as reference standards. Three abdominal radiologists assigned categories independently and in consensus using LI-RADSv2017, LI-RADSv2018, and OPTN criteria. Diagnostic performance was compared among the guidelines with a generalized estimating equation. RESULTS. Fourteen of 159 (8.8%) observations were assigned a different category according to LI-RADSv2018 compared with LI-RADSv2017. Eight of 31 (25.8%) LR-4 observations using v2017 were recategorized as LR-5 using v2018, and all eight were HCC. Six of 31 (19.4%) LR-4 observations based on v2017 were recategorized as LR-3 using v2018, and all six were non-HCCs. Seven of 114 (6.1%) observations not meeting OPTN class 5 criteria were LR-5 using v2018, and all seven were HCC. Sensitivity for HCC of LR-5 and LR-TIV+5 (i.e., LR-TIV [tumor in vein] definitely due to HCC) categories based on v2018 was significantly higher than that based on v2017 (63.9% vs 55.2%, respectively; p = 0.008) without a difference in specificity (97.3% vs 97.3%; p = 1.00). Sensitivity of LR-5 and LR-TIV+5 in LI-RADSv2018 was significantly higher than the sensitivity of class 5 in OPTN criteria (63.9% vs 53.6%; p = 0.004) without a difference in specificity (97.3% vs 97.3%; p = 1.00). Reader agreement was moderate for overall LIRADSv2017 and LI-RADSv2018 categories (κ = 0.504 and 0.561, respectively); substantial for LR-5 and LR-TIV+5 categories as diagnostic of HCC versus other categories for both v2017 and v2018 (κ = 0.758 and 0.802, respectively); and substantial for OPTN class 5 criteria (κ = 0.756). CONCLUSION. The diagnostic performance of LI-RADSv2018 is higher, with higher sensitivity and similar specificity, than the diagnostic performance of LI-RADSv2017 and OPTN criteria for HCC.
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15
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Jackson WC, Tang M, Maurino C, Mendiratta-Lala M, Parikh ND, Matuszak MM, Dow JS, Cao Y, Mayo CS, Ten Haken RK, Schipper MJ, Cuneo KC, Owen D, Lawrence TS. Individualized Adaptive Radiation Therapy Allows for Safe Treatment of Hepatocellular Carcinoma in Patients With Child-Turcotte-Pugh B Liver Disease. Int J Radiat Oncol Biol Phys 2020; 109:212-219. [PMID: 32853708 DOI: 10.1016/j.ijrobp.2020.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 08/03/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Previous reports of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) suggest unacceptably high rates of toxicity in patients with Child-Turcotte-Pugh (CTP) B liver disease. We hypothesized that an individualized adaptive treatment approach based on midtreatment liver function would maintain good local control while limiting toxicity in this population. METHODS AND MATERIALS Patients with CTP-B liver disease and HCC were treated on prospective trials of individualized adaptive SBRT between 2006 and 2018. Patients underwent pre- and midtreatment liver function assessments using indocyanine green. Treatment-related toxicity was defined as a ≥2-point increase in CTP score from pretreatment within 6 months of treatment. In addition, we performed analyses with a longitudinal model to assess changes in CTP score over 12 months after SBRT. RESULTS Eighty patients with CTP-B (median tumor size, 2.5 cm) were treated: 37 patients were CTP-B-7, 28 were CTP-B-8, and 15 were CTP-B-9. The median treatment dose was 36 Gy in 3 fractions. One-year local control was 92%. In a multivariate model controlling for tumor size, treatment dose, and baseline CTP score, higher treatment dose was associated with improved freedom from local progression (hazard ratio: 0.97; 95% confidence interval, 0.94-1.00; P = .04). Eighteen patients (24%) had a ≥2-point increase in CTP score within 6 months of SBRT. In a longitudinal model assessing changes in CTP score over 12 months after SBRT, controlling for baseline CTP and tumor size, increasing mean liver dose was associated with larger increases in CTP score (P = .04). CONCLUSIONS An individualized adaptive treatment approach allows for acceptable toxicity and effective local control in patients with HCC and CTP-B liver disease. Because increasing dose may increase both local control and toxicity, further work is needed to optimize treatment in patients with compromised liver function.
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Affiliation(s)
- William C Jackson
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan.
| | - Ming Tang
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Christopher Maurino
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | | | - Neehar D Parikh
- University of Michigan Department of Gastroenterology, Ann Arbor, Michigan
| | - Martha M Matuszak
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Janell S Dow
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Yue Cao
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Charles S Mayo
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Randall K Ten Haken
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Matthew J Schipper
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Kyle C Cuneo
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Dawn Owen
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Theodore S Lawrence
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
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Lee S, Kim YY, Shin J, Hwang SH, Roh YH, Chung YE, Choi JY. CT and MRI Liver Imaging Reporting and Data System Version 2018 for Hepatocellular Carcinoma: A Systematic Review With Meta-Analysis. J Am Coll Radiol 2020; 17:1199-1206. [PMID: 32640250 DOI: 10.1016/j.jacr.2020.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to determine the diagnostic performance of the LR-5 category for hepatocellular carcinoma (HCC) and the pooled proportion of HCC in each Liver Imaging Reporting and Data System (LI-RADS) category with CT and MRI, using LI-RADS version 2018. METHODS The MEDLINE, Embase, and Scopus databases were searched from inception to December 7, 2019, for studies reporting the diagnostic accuracy of LI-RADS version 2018 for HCC. Risk for bias and concerns regarding applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Random-effects models were used to determine the summary estimates of the diagnostic performance of LR-5 and the pooled proportion of HCC for each LI-RADS category. RESULTS Fourteen studies were included in the final analysis, consisting of 2,708 observations with 1,841 HCCs. The pooled per-observation sensitivity and specificity of the LR-5 category for diagnosing HCC were 70% (95% confidence interval [CI], 61%-78%) and 91% (95% CI, 89%-93%), respectively. No HCCs were reported for LR-1 and LR-2. The pooled proportions of HCC were 31% (95% CI, 12%-50%) for LR-3, 64% (95% CI, 47%-80%) for LR-4, 95% (95% CI, 93%-96%) for LR-5, 54% (95% CI, 30%-77%) for LR-TIV, and 33% (95% CI, 21%-46%) for LR-M. The proportions of HCC were significantly different among the LI-RADS categories (P = .022). CONCLUSIONS The LR-5 category of LI-RADS version 2018 provided moderate sensitivity and high specificity for diagnosing HCC. Higher LI-RADS categories from LR-3 to LR-5 included greater proportions of HCC.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeseung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hye Hwang
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Liver Imaging Reporting and Data System Version 2018: What Radiologists Need to Know. J Comput Assist Tomogr 2020; 44:168-177. [PMID: 32195795 DOI: 10.1097/rct.0000000000000995] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this article, we aim to review Liver Imaging Reporting and Data System version 18 (LI-RADS v2018). Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Liver Imaging Reporting and Data System developed for standardizing interpreting, reporting, and data collection of HCC describes 5 major features for accurate HCC diagnosis and several ancillary features, some favoring HCC in particular or malignancy in general and others favoring benignity. Untreated hepatic lesions LI-RADS affords 8 unique categories based on imaging appearance on computed tomography and magnetic resonance imaging, which indicate the possibility of HCC or malignancy with or without tumor in vein. Furthermore, LI-RADS defines 4 treatment response categories for treated HCCs after different locoregional therapy. These continuous recent updates on LI-RADS improve the communication between the radiologists and the clinicians for better management and patient outcome.
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18
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Kanmaniraja D, Dellacerra G, Holder J, Erlichman D, Chernyak V. Liver Imaging Reporting and Data System (LI-RADS) v2018: Review of the CT/MRI Diagnostic Categories. Can Assoc Radiol J 2020; 72:142-149. [PMID: 32063008 DOI: 10.1177/0846537119888393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system that provides standardization in the interpretation and reporting of observations in patients at risk of developing hepatocellular carcinoma (HCC). Computed tomography/magnetic resonance imaging (CT/MRI) LI-RADS v2018 includes 8 diagnostic categories, which reflect the probability of benignity, malignancy in general, or HCC specifically. This article reviews the diagnostic categories of CT/MRI LI-RADS v2018, highlighting the key imaging features, diagnostic criteria, and management implications.
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Affiliation(s)
| | - Gary Dellacerra
- Department of Radiology, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Justin Holder
- Department of Radiology, 2013Montefiore Medical Center, Bronx, NY, USA
| | - David Erlichman
- Department of Radiology, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Victoria Chernyak
- Department of Radiology, 2013Montefiore Medical Center, Bronx, NY, USA
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