Do Risk Factors for HCC Impact the Association of CT/MRI LIRADS Major Features With HCC? An Individual Participant Data Meta-Analysis

Robert G Adamo; Eric Lam; Jean-Paul Salameh; Christian B van der Pol; Stacy M Goins; Haben Dawit; Andreu F Costa; Brooke Levis; Amit G Singal; Victoria Chernyak; Claude B Sirlin; Mustafa R Bashir; An Tang; Ayman Alhasan; Brian C Allen; Caecilia S Reiner; Christopher Clarke; Daniel R Ludwig; Milena Cerny; Jin Wang; Sang Hyun Choi; Tyler J Fraum; Bin Song; Ijin Joo; So Yeon Kim; Heejin Kwon; Hanyu Jiang; Hyo-Jin Kang; Andrea S Kierans; Yeun-Yoon Kim; Maxime Ronot; Joanna Podgórska; Grzegorz Rosiak; Ji Soo Song; Matthew D F McInnes

doi:10.1177/08465371241306297

Do Risk Factors for HCC Impact the Association of CT/MRI LIRADS Major Features With HCC? An Individual Participant Data Meta-Analysis

Can Assoc Radiol J. 2024 Dec 29:8465371241306297. doi: 10.1177/08465371241306297. Online ahead of print.

Authors

Robert G Adamo¹, Eric Lam², Jean-Paul Salameh¹, Christian B van der Pol³, Stacy M Goins⁴, Haben Dawit⁵, Andreu F Costa⁶, Brooke Levis⁷, Amit G Singal⁸, Victoria Chernyak⁹, Claude B Sirlin¹⁰, Mustafa R Bashir^{11

12

13}, An Tang¹⁴, Ayman Alhasan^{15

16}, Brian C Allen¹⁷, Caecilia S Reiner¹⁸, Christopher Clarke¹⁹, Daniel R Ludwig²⁰, Milena Cerny²¹, Jin Wang²², Sang Hyun Choi²³, Tyler J Fraum²⁰, Bin Song²⁴, Ijin Joo²⁵, So Yeon Kim²³, Heejin Kwon²⁶, Hanyu Jiang²⁴, Hyo-Jin Kang²⁷, Andrea S Kierans²⁸, Yeun-Yoon Kim²⁹, Maxime Ronot³⁰, Joanna Podgórska³¹, Grzegorz Rosiak³¹, Ji Soo Song³², Matthew D F McInnes³³

Affiliations

¹ Faculty of Medicine at The University of Ottawa, Ottawa, ON, Canada.
² Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
⁴ Duke University School of Medicine, Durham, NC, USA.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
⁷ Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
⁸ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁹ Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
¹⁰ Liver Imaging Group, Department of Radiology, UC San Diego, La Jolla, CA, USA.
¹¹ Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC, USA.
¹² Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC, USA.
¹³ Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
¹⁴ Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
¹⁵ Department of Radiology, College of Medicine, Taibah University, Medina, Saudi Arabia.
¹⁶ Department of Radiology, King Faisal Specialist Hospital and Research Centre, Medina, Saudi Arabia.
¹⁷ Department of Radiology, Duke University Medical Center, Durham, NC, USA.
¹⁸ Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
¹⁹ Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
²⁰ Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
²¹ Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
²² Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
²³ Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²⁴ Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
²⁵ Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea.
²⁶ Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Seogu, Busan, South Korea.
²⁷ Department of Radiology, Seoul National University Hospital, Seoul, South Korea.
²⁸ Weill Cornell Medical Center, New York, NY, USA.
²⁹ Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
³⁰ Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université Paris Cité, CRI UMR 1149, Paris, France.
³¹ 2nd Radiology Department, Warsaw Medical University, Warsaw, Poland.
³² Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea.
³³ Rm c-159 Departments of Radiology and Epidemiology, University of Ottawa, Ottawa, ON, Canada.

PMID: 39733353
DOI: 10.1177/08465371241306297

Abstract

Background: Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. Purpose: To evaluate whether the association between HCC risk factors and each CT/MRI LI-RADS major feature differs among individuals at-risk for HCC. Methods: Databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched from 2014 to 2022. Individual participant data (IPD) were extracted from studies evaluating HCC diagnosis using CT/MRI LI-RADS and reporting HCC risk factors. IPD from studies were pooled and modelled with one-stage meta-regressions. Interactions were assessed between major features and HCC risk factors, including age, sex, cirrhosis, chronic hepatitis B virus (HBV), and study location. A mixed effects model that included the major features, as well as separate models that included interactions between each risk factor and each major feature, were fit. Differences in interactions across levels of each risk factor were calculated using adjusted odds-ratios (ORs), 95% confidence-intervals (CI), and z-tests. Risk of bias was assessed using QUADAS-2. (Protocol: https://osf.io/tdv7j/). Results: Across 23 studies (2958 patients and 3553 observations), the associations between LI-RADS major features and HCC were consistent across several HCC risk factors (P-value range: .09-.99). A sensitivity analysis among the 4 studies with a low risk of bias did not differ from the primary analysis. Conclusion: The association between CT/MRI LI-RADS major features and HCC risk factors do not significantly differ in individuals at-risk for HCC. These findings suggest that CT/MR LI-RADS should be applied to all patients considered at risk by LI-RADS without modification or exclusions, regardless of the presence or absence of the risk factors evaluated in this study.

Keywords: CT/MRI; HCC; LI-RADS; major features; risk factors.