TY - JOUR
T1 - Comparative Performance of 2018 LI-RADS versus Modified LIRADS (mLI-RADS)
T2 - An Individual Participant Data Meta-Analysis
AU - Goins, Stacy M.
AU - Jiang, Hanyu
AU - van der Pol, Christian B.
AU - Salameh, Jean Paul
AU - Lam, Eric
AU - Adamo, Robert G.
AU - McInnes, Matthew D.F.
AU - Costa, Andreu F.
AU - Clarke, Christopher
AU - Choi, Sang Hyun
AU - Fraum, Tyler J.
AU - Ludwig, Daniel R.
AU - Song, Bin
AU - Joo, Ijin
AU - Kierans, Andrea S.
AU - Kim, So Yeon
AU - Kwon, Heejin
AU - Podgórska, Joanna
AU - Rosiak, Grzegorz
AU - Bashir, Mustafa R.
N1 - Publisher Copyright:
© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.
PY - 2024/9
Y1 - 2024/9
N2 - 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. Level of Evidence: 3. Technical Efficacy: Stage 2.
AB - 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. Level of Evidence: 3. Technical Efficacy: Stage 2.
KW - EOB-DTPA
KW - LI-RADS
KW - MRI
KW - gadoxetate disodium
KW - hepatocellular carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85178491607&partnerID=8YFLogxK
U2 - 10.1002/jmri.29167
DO - 10.1002/jmri.29167
M3 - Article
C2 - 38038346
AN - SCOPUS:85178491607
SN - 1053-1807
VL - 60
SP - 1082
EP - 1091
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
IS - 3
ER -