Validation of Liver Imaging Reporting and Data System 2017 (LI-RADS) Criteria for Imaging Diagnosis of Hepatocellular Carcinoma

Background: The Liver Imaging Reporting and Data System (LI-RADS) is being adapted by many clinical practices. To support continuation of its use, LI-RADS (LR) is in need of multicenter validation studies of recent LI-RADS iterations. Furthermore, while both gadoxetate and extracellular agents have been incorporated into LI-RADS, comparison of the diagnostic performance between the two has yet to be determined.

Purpose/hypothesis: To evaluate the rate, diagnostic performance, and interreader reliability (IRR) of LI-RADS 2017 for hepatocellular carcinoma, including LR major and ancillary features, with both gadoxetate and extracellular agent-enhanced MRI against a reference standard of histopathology or imaging follow-up.

Study type: Retrospective.

Population: In all, 114 patients with 144 observations were included who met LR 2017 criteria for at risk and had at least one hepatic observation on liver MRI performed with either gadoxetate (n = 52) or an extracellular agent (n = 92) between 2010-2016, with histopathology (n = 103) or follow-up imaging (n = 41).

Field strength/sequence: 1.5 and 3.0T/T₁ -T₂ WI, diffusion-weighted imaging.

Assessment: Three radiologists independently assessed major/ancillary features and assigned overall LI-RADS category for every observation.

Statistical tests: Diagnostic performance of LR5/TIV+LR5 for identifying hepatocellular carcinoma (HCC) was compared between contrast agents with a generalized estimating equation. Weighted kappa was performed for interrater reliability.

Results: The frequency of HCCs among LR1, LR2, LR3, L4, LR5, LRTIV+LR5, and LRM observations were: 0% (all readers), 0-12.5%, 11.4-26.9%, 50-76%, 83.0-95.1%, 83.3-100.0%, and 45.0-65.0%, respectively. Sensitivity of LR5/LRTIV+LR5 for HCC was 59.7-71.4% and specificity 85.0-96.8%. LI-RADS specificity and positive predictive value for observations imaged with gadoxetate was higher than extracellular agent for the most inexperienced reader (R3) (P = 0.009-0.034). IRR for LI-RADS categorization was substantial (k = 0.661).

Data conclusion: Increasing numerical LI-RADS 2017 categories demonstrate a greater percentage of HCCs. LR5/TIV+LR5 demonstrates excellent specificity and fair sensitivity for HCC. MRI with gadoxetate in liver transplant candidates may be beneficial for less experienced readers, although further large-scale prospective studies are needed.

Level of evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:e205-e215.