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LI-RADS Major Features on MRI for Diagnosing Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

 Jaeseung Shin  ;  Sunyoung Lee  ;  Ja Kyung Yoon  ;  Yong Eun Chung  ;  Jin-Young Choi  ;  Mi-Suk Park 
 JOURNAL OF MAGNETIC RESONANCE IMAGING, Vol.54(2) : 518-525, 2021-08 
Journal Title
Issue Date
contrast media ; diagnosis ; liver neoplasms ; magnetic resonance imaging ; sensitivity and specificity
Background: The reported diagnostic performance for hepatocellular carcinoma (HCC) of each major imaging feature on MRI using standardized definitions of the Liver Imaging Reporting and Data System (LI-RADS) is variable. It is important to know the actual performance of each LI-RADS major imaging feature for imaging diagnosis of HCC and determine the sources of heterogeneity between the reported results.

Purpose: To systematically determine the performance of each major imaging feature of LI-RADS for diagnosing HCC using either extracellular contrast agent-enhanced MRI (ECA-MRI) or gadoxetate disodium-enhanced MRI (EOB-MRI).

Study type: Systematic review and meta-analysis.

Subjects: Sixteen original articles with 3542 lesions.

Field strength: A 1.5 T and 3.0 T.

Assessment: Data extraction was independently performed by two reviewers who identified and reviewed original articles reporting the diagnostic performance of each LI-RADS major imaging feature-arterial phase hyperenhancement (APHE), observation size, washout appearance, enhancing "capsule," and threshold growth-using MRI. Study characteristics, study population characteristics, MRI characteristics, contrast agent, LI-RADS version, reference standards, and study outcomes were extracted from included studies. Risk of bias and concerns regarding applicability were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Statistical tests: Bivariate random-effects models were used to obtain summary estimates of the diagnostic performance of each LI-RADS major imaging feature. Hierarchical summary receiver operating characteristic curves were plotted. Meta-regression analyses were performed to explore potential sources of heterogeneity.

Results: The pooled per-observation sensitivities and specificities for diagnosing HCC were 85% (95% confidence interval [CI] = 78%-89%) and 57% (95% CI = 44%-70%) for arterial phase hyperenhancement (APHE), 77% (95% CI = 72%-82%), and 74% (95% CI = 63%-83%) for washout appearance, and 52% (95% CI = 41%-64%) and 90% (95% CI = 85%-94%) for enhancing "capsule," respectively.

Data conclusions: Among the LI-RADS major features, the sensitivity was the highest for APHE and the specificity was the highest for enhancing "capsule" in the diagnosis of HCC.

Evidence level: 3 TECHNICAL EFFICACY: Stage 2.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Shin, Jaeseung(신재승) ORCID logo https://orcid.org/0000-0002-6755-4732
Yoon, Ja Kyung(윤자경) ORCID logo https://orcid.org/0000-0002-3783-977X
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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