Comparative Performance of 2018 <scp>LI‐RADS</scp> versus Modified <scp>LIRADS</scp> (<scp>mLI‐RADS</scp>): An Individual Participant Data Meta‐Analysis

doi:10.1002/jmri.29167

DOI: 10.1002/jmri.29167 ISSN: 1053-1807

Comparative Performance of 2018 LI‐RADS versus Modified LIRADS (mLI‐RADS): An Individual Participant Data Meta‐Analysis

Stacy M. Goins, Hanyu Jiang, Christian B. van der Pol, Jean‐Paul Salameh, Eric Lam, Robert G. Adamo, Matthew D.F. McInnes, Andreu F. Costa, Christopher Clarke, Sang Hyun Choi, Tyler J. Fraum, Daniel R. Ludwig, Bin Song, Ijin Joo, Andrea S. Kierans, So Yeon Kim, Heejin Kwon, Joanna Podgórska, Grzegorz Rosiak, Mustafa R. Bashir

Radiology, Nuclear Medicine and imaging

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Background

LI‐RADS version 2018 (v2018) is used for non‐invasive diagnosis of hepatocellular carcinoma (HCC). A recently proposed modification (known as mLI‐RADS) demonstrated improved sensitivity while maintaining specificity and positive predictive value (PPV) of LI‐RADS category 5 (definite HCC) for HCC. However, mLI‐RADS requires multicenter validation.

Purpose

To evaluate the performance of v2018 and mLI‐RADS for liver lesions in a large, heterogeneous, multi‐national cohort of patients at risk for HCC.

Study Type

Systematic review and meta‐analysis using individual participant data (IPD) [Study Protocol: https://osf.io/duys4].

Population

2223 observations from 1817 patients (includes all LI‐RADS categories; females = 448, males = 1361, not reported = 8) at elevated risk for developing HCC (based on LI‐RADS population criteria) from 12 retrospective studies.

Field Strength/Sequence

1.5T and 3T; complete liver MRI with gadoxetate disodium, including axial T2w images and dynamic axial fat‐suppressed T1w images precontrast and in the arterial, portal venous, transitional, and hepatobiliary phases. Diffusion‐weighted imaging was used when available.

Assessment

Liver observations were categorized using v2018 and mLI‐RADS. The diagnostic performance of each system's category 5 (LR‐5 and mLR‐5) for HCC were compared.

Statistical Tests

The Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS‐2 was applied to determine risk of bias and applicability. Diagnostic performances were assessed using the likelihood ratio test for sensitivity and specificity and the Wald test for PPV. The significance level was P < 0.05.

Results

17% (2/12) of the studies were considered low risk of bias (244 liver observations; 164 patients). When compared to v2018, mLR‐5 demonstrated higher sensitivity (61.3% vs. 46.5%, P < 0.001), similar PPV (85.3% vs. 86.3%, P = 0.89), and similar specificity (85.8% vs. 90.8%, P = 0.16) for HCC.

Data Conclusion

This study confirms mLR‐5 has higher sensitivity than LR‐5 for HCC identification, while maintaining similar PPV and specificity, validating the mLI‐RADS proposal in a heterogeneous, international cohort.

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