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Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis

  • Hepatobiliary-Pancreas
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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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Abbreviations

CI:

Confidence interval

CT:

Computed tomography

ECA:

Extracellular agent

Gx:

Gadoxetate disodium

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LR-5:

Liver Imaging Reporting and Data System category 5

MRI:

Magnetic resonance imaging

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Funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number: RS-2023-00244520). Funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Sunyoung Lee, Yeun-Yoon Kim & **-Young Choi

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jaeseung Shin

  3. Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yun Ho Roh

  4. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Victoria Chernyak

  5. Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA

    Claude B. Sirlin

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Correspondence to Sunyoung Lee.

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The scientific guarantor of this publication is Sunyoung Lee.

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The authors of this manuscript declare relationships with the following companies:

Victoria Chernyak: Bayer consultant; Gilead consultant. Victoria Chernyak is also a member of the European Radiology Editorial Board. They have not taken part in the review or selection process of this article.

Claude B. Sirlin: Dr. Sirlin reports grants from Bayer, GE, Gilead, Pfizer, Philips, Siemens; lab service agreements with Enanta, Gilead, ICON, Intercept, Nusirt, Shire, Synageva, Takeda; institutional consulting for BMS, Exact Sciences, IBM-Watson, Pfizer; Persona consulting for Blade, Boehringer, Epigenomics; receipt of royalties and/or honoraria from Medscape and Wolters Kluwer; ownership of stock options in Livivos; unpaid advisory board position in Quantix Bio.

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One of the authors (Yun Ho Roh) has significant statistical expertise.

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Lee, S., Kim, YY., Shin, J. et al. Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis. Eur Radiol 34, 1502–1514 (2024). https://doi.org/10.1007/s00330-023-10134-z

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