Diagnostic performance of MR for hepatocellular carcinoma based on LI-RADS v2018, compared with v2017

Background: The Liver Imaging Reporting and Data System (LI-RADS) is widely adopted for noninvasive diagnosis of hepatocellular carcinoma (HCC). It's updated to version 2018 recently, with some major changes compared with v2017. However, the diagnostic performance of LI-RADS v2018 and its difference with v2017 are yet to be validated.

Purpose: To compare the diagnostic performances of LI-RADS on MR for diagnosing HCC between v2017 and v2018.

Study type: Retrospective.

Subjects: In all, 181 patients with 217 hepatic observations (146 HCCs, 16 non-HCC malignancies and 55 benign lesions) with liver MRI and pathological or follow-up imaging diagnoses.

Field strength/sequence: 1.5 T or 3 T MRI. Dual-echo T₁ WI, T₂ WI, diffusion-weighted imaging, and a liver acquisition with volume acceleration. Assessment Images were independently interpreted by three radiologists, and then in consensus for observations with different LR categories, according to LI-RADS v2017 and v2018, separately.

Statistical tests: Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and Youden index.

Results: When adopting LR-5 as a predictor of HCC, the sensitivity (80.8% vs. 71.2%), NPV (69.6% vs. 60.7%), and accuracy (83.9% vs. 77.9%) were all increased for LI-RADS v2018 compared with v2017, with a greater Youden index (0.709 vs. 0.627). However, the diagnostic performances of MRI for diagnosing HCC were not changed while adopting LR-4/5 as a predictor. The threshold growths of 76% (19/25) observations in v2017 were revised to subthreshold growth in v2018, and 16 LR-4 observations in v2017 were changed to LR-5 based on v2018.

Data conclusion: The diagnostic performance of LI-RADS v2018 for diagnosing HCC is superior to v2017, with a greater sensitivity, NPV, and accuracy. The revisions in v2018 mainly affect the categorization when adopting LR-5 as a predictor of HCC.

Level of evidence: 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:746-755.