Search

Background: Hepatocellular carcinoma (HCC) can be diagnosed without pathologic confirmation in high‐risk patients. Therefore, it is necessary to compare current imaging criteria for noninvasive‐diagnosis of HCC. Purpose: To systematically compare performance of 2018 European Association for the Study of the Liver (EASL) criteria and Liver Imaging Reporting and Data System (LI‐RADS) for noninvasive‐diagnosis of HCC. Study Type: Systematic review and meta‐analysis. Subjects: Eight studies with 2232 observations, including 1617 HCCs. Field Strength/Sequence: 1.5 T, 3.0 T/T2‐weighted, unenhanced T1‐weighted in‐/opposed‐phases, multiphase T1‐weighted imaging. Assessment: Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, two reviewers independently reviewed and extracted data, including patient characteristics, index test, reference standard and outcomes, from studies intraindividually comparing the sensitivities and specificities of 2018 EASL‐criteria and LR‐5 of LI‐RADS for HCC. Risk of bias and concerns regarding applicability were evaluated using QUADAS‐2 tool. Subgroup analysis was performed based on observation size (≥20 mm, 10–19 mm). Statistical Tests: Bivariate random‐effects model to calculate pooled per‐observation sensitivity and specificity of both imaging criteria, and pooled estimates of intraindividual paired data were compared considering the correlation. Forest and linked‐receiver‐operating‐characteristic plots were drawn, and study heterogeneity was assessed using Q‐test and Higgins‐index. Publication bias was evaluated by Egger's test. A P‐value <0.05 was considered statistically significant, except for heterogeneity (P < 0.10). Results: The sensitivity for HCC did not differ significantly between the imaging‐based diagnosis using EASL‐criteria (61%; 95% CI, 50%–73%) and LR‐5 (64%; 95% CI, 53%–76%; P = 0.165). The specificities were also not significantly different between EASL‐criteria (92%; 95% CI, 89%–94%) and LR‐5 (94%; 95% CI, 91%–96%; P = 0.257). In subgroup analysis, no statistically significant differences were identified in the pooled performances between the two criteria for observations ≥20 mm (sensitivity P = 0.065; specificity P = 0.343) or 10–19 mm (sensitivity P > 0.999; specificity P = 0.851). There was no publication bias for EASL (P = 0.396) and LI‐RADS (P = 0.526). Data Conclusion: In the present meta‐analysis of paired comparisons, the pooled sensitivities and specificities were not significantly different between 2018 EASL‐criteria and LR‐5 of LI‐RADS for noninvasive‐diagnosis of HCC. Evidence Level: 3. Technical Efficacy: Stage 2. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Background: The reported diagnostic performance for hepatocellular carcinoma (HCC) of each major imaging feature on MRI using standardized definitions of the Liver Imaging Reporting and Data System (LI‐RADS) is variable. It is important to know the actual performance of each LI‐RADS major imaging feature for imaging diagnosis of HCC and determine the sources of heterogeneity between the reported results. Purpose: To systematically determine the performance of each major imaging feature of LI‐RADS for diagnosing HCC using either extracellular contrast agent‐enhanced MRI (ECA‐MRI) or gadoxetate disodium‐enhanced MRI (EOB‐MRI). Study Type: Systematic review and meta‐analysis. Subjects: Sixteen original articles with 3542 lesions. Field Strength: A 1.5 T and 3.0 T. Assessment: Data extraction was independently performed by two reviewers who identified and reviewed original articles reporting the diagnostic performance of each LI‐RADS major imaging feature—arterial phase hyperenhancement (APHE), observation size, washout appearance, enhancing "capsule," and threshold growth—using MRI. Study characteristics, study population characteristics, MRI characteristics, contrast agent, LI‐RADS version, 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 obtain summary estimates of the diagnostic performance of each LI‐RADS major imaging feature. Hierarchical summary receiver operating characteristic curves were plotted. Meta‐regression analyses were performed to explore potential sources of heterogeneity. Results: The pooled per‐observation sensitivities and specificities for diagnosing HCC were 85% (95% confidence interval [CI] = 78%–89%) and 57% (95% CI = 44%–70%) for arterial phase hyperenhancement (APHE), 77% (95% CI = 72%–82%), and 74% (95% CI = 63%–83%) for washout appearance, and 52% (95% CI = 41%–64%) and 90% (95% CI = 85%–94%) for enhancing "capsule," respectively. Data Conclusions: Among the LI‐RADS major features, the sensitivity was the highest for APHE and the specificity was the highest for enhancing "capsule" in the diagnosis of HCC. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background & aims: Contrast‐enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing CEUS at high risk for hepatocellular carcinoma (HCC). We performed a meta‐analysis to determine the diagnostic performance of the CEUS LR‐5 for HCC and the pooled proportions of HCCs in each CEUS LI‐RADS category. Methods: We searched multiple databases for studies reporting the diagnostic accuracy of the CEUS LI‐RADS. Random‐effects model was used to determine summary estimates of the diagnostic performance of CEUS LR‐5 and the pooled proportions of HCCs in each CEUS LI‐RADS category. Risk of bias and concerns regarding applicability were evaluated with the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Results: Eleven studies were included in the final analysis, which consisted of 5535 observations with 3983 HCCs. The pooled per‐observation sensitivity and specificity of the CEUS LR‐5 for diagnosing HCC were 69% (95% confidence interval [CI], 64%–73%) and 92% (95% CI, 83%–96%) respectively. The pooled proportions of HCCs were 0% (95% CI, 0‐0%) for LR‐1, 1% (95% CI, 0%–4%) for CEUS LR‐2, 26% (95% CI, 14%–39%) for CEUS LR‐3, 77% (95% CI, 68%–86%) for CEUS LR‐4, 97% (95% CI, 95%–98%) for CEUS LR‐5, 57% (95% CI, 44%–69%) for CEUS LR‐M and 100% (95% CI, 93%–100%) for CEUS LR‐5V or TIV. Conclusions: The CEUS LR‐5 category showed moderate sensitivity and high specificity for diagnosing HCC. The proportion of HCCs was higher in the higher CEUS LI‐RADS categories. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background & Aims: The liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing liver imaging in patients at high risk for hepatocellular carcinoma (HCC). We performed a meta‐analysis to determine the diagnostic performance of the LR‐5 category for HCC and the pooled proportions of HCCs in each LI‐RADS category using CT/MRI LI‐RADS v2017. Methods: We searched multiple databases for original studies reporting on the diagnostic accuracy of CT/MRI LI‐RADS v2017. Random‐effects models were used to determine the summary estimates of the diagnostic performance of the LR‐5 category and the pooled proportions of HCCs for each LI‐RADS category. Risk of bias and concerns regarding applicability were evaluated with the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Results: Fourteen studies (3 prospective studies and 11 retrospective studies) were included in the final analysis, consisting of 2056 patients, 2589 observations, and 1693 HCCs. The pooled per‐observation sensitivity was 67% (95% confidence interval [CI], 62%‐72%) with specificity of 92% (95% CI, 88%‐95%) in the LR‐5 category of CT/MRI LI‐RADS v2017 for diagnosing HCC. The pooled proportions of HCCs were 0% (95% CI, 0%‐0%) for LR‐1, 4% (95% CI, 0%‐8%) for LR‐2, 34% (95% CI, 23%‐44%) for LR‐3, 67% (95% CI, 53%‐81%) for LR‐4, and 92% (95% CI, 87%‐96%) for LR‐5. The proportions of HCCs were significantly different among LI‐RADS categories 1‐5 (P =.034). Conclusions: The LR‐5 category of CT/MRI LI‐RADS v2017 shows moderate sensitivity and high specificity for diagnosing HCC. Higher LI‐RADS categories contained higher proportions of HCCs. [ABSTRACT FROM AUTHOR]