Diagnostic Performance of LI-RADS Version 2018, LI-RADS Version 2017, and OPTN Criteria for Hepatocellular Carcinoma.

Abstract

<b>OBJECTIVE.</b> Liver Imaging Reporting and Data System (LI-RADS) was updated in 2018 (LI-RADS version 2018 [LI-RADSv2018]) to facilitate integration into the American Association for the Study of Liver Diseases 2018 clinical practice guidelines and involved changes in LR-5 categorization and threshold growth definitions. There are also differences between the criteria for LI-RADSv2018 LR-5 category and the criteria for Organ Procurement and Transplantation Network (OPTN) class 5. The objective of our study was to compare the diagnostic performances of LI-RADSv2018, LI-RADS version 2017 (LI-RADSv2017), and OPTN criteria for diagnosing hepatocellular carcinoma (HCC) on MRI. <b>MATERIALS AND METHODS.</b> In this retrospective study, 122 patients with 159 observations were included who met LI-RADS criteria for at risk for HCC and had at least one hepatic observation on MRI performed between January 1, 2015, and January 1, 2018 and who had histopathology results (<i>n</i> = 104) or follow-up imaging (<i>n</i> = 55) as reference standards. Three abdominal radiologists assigned categories independently and in consensus using LI-RADSv2017, LI-RADSv2018, and OPTN criteria. Diagnostic performance was compared among the guidelines with a generalized estimating equation. <b>RESULTS.</b> Fourteen of 159 (8.8%) observations were assigned a different category according to LI-RADSv2018 compared with LI-RADSv2017. Eight of 31 (25.8%) LR-4 observations using v2017 were recategorized as LR-5 using v2018, and all eight were HCC. Six of 31 (19.4%) LR-4 observations based on v2017 were recategorized as LR-3 using v2018, and all six were non-HCCs. Seven of 114 (6.1%) observations not meeting OPTN class 5 criteria were LR-5 using v2018, and all seven were HCC. Sensitivity for HCC of LR-5 and LR-TIV+5 (i.e., LR-TIV [tumor in vein] definitely due to HCC) categories based on v2018 was significantly higher than that based on v2017 (63.9% vs 55.2%, respectively; <i>p</i> = 0.008) without a difference in specificity (97.3% vs 97.3%; <i>p</i> = 1.00). Sensitivity of LR-5 and LR-TIV+5 in LI-RADSv2018 was significantly higher than the sensitivity of class 5 in OPTN criteria (63.9% vs 53.6%; <i>p</i> = 0.004) without a difference in specificity (97.3% vs 97.3%; <i>p</i> = 1.00). Reader agreement was moderate for overall LIRADSv2017 and LI-RADSv2018 categories (κ = 0.504 and 0.561, respectively); substantial for LR-5 and LR-TIV+5 categories as diagnostic of HCC versus other categories for both v2017 and v2018 (κ = 0.758 and 0.802, respectively); and substantial for OPTN class 5 criteria (κ = 0.756). <b>CONCLUSION.</b> The diagnostic performance of LI-RADSv2018 is higher, with higher sensitivity and similar specificity, than the diagnostic performance of LI-RADSv2017 and OPTN criteria for HCC.