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Diagnostic Performance of the 2018 EASL vs. LI-RADS for Hepatocellular Carcinoma Using CT and MRI: A Systematic Review and Meta-Analysis of Comparative Studies

 Jaeseung Shin  ;  Sunyoung Lee  ;  Ja Kyung Yoon  ;  Yun Ho Roh 
 JOURNAL OF MAGNETIC RESONANCE IMAGING, Vol.58(6) : 1942-1950, 2023-12 
Journal Title
Issue Date
Carcinoma, Hepatocellular* / diagnostic imaging ; Carcinoma, Hepatocellular* / pathology ; Contrast Media ; Humans ; Liver Neoplasms* / diagnostic imaging ; Liver Neoplasms* / pathology ; Magnetic Resonance Imaging / methods ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed / methods
computed tomography ; diagnosis ; liver neoplasms ; magnetic resonance imaging ; sensitivity and specificity
Background: Hepatocellular carcinoma (HCC) can be diagnosed without pathologic confirmation in high-risk patients. Therefore, it is necessary to compare current imaging criteria for noninvasive-diagnosis of HCC.

Purpose: To systematically compare performance of 2018 European Association for the Study of the Liver (EASL) criteria and Liver Imaging Reporting and Data System (LI-RADS) for noninvasive-diagnosis of HCC.

Study type: Systematic review and meta-analysis.

Subjects: Eight studies with 2232 observations, including 1617 HCCs.

Field strength/sequence: 1.5 T, 3.0 T/T2-weighted, unenhanced T1-weighted in-/opposed-phases, multiphase T1-weighted imaging.

Assessment: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two reviewers independently reviewed and extracted data, including patient characteristics, index test, reference standard and outcomes, from studies intraindividually comparing the sensitivities and specificities of 2018 EASL-criteria and LR-5 of LI-RADS for HCC. Risk of bias and concerns regarding applicability were evaluated using QUADAS-2 tool. Subgroup analysis was performed based on observation size (≥20 mm, 10-19 mm).

Statistical tests: Bivariate random-effects model to calculate pooled per-observation sensitivity and specificity of both imaging criteria, and pooled estimates of intraindividual paired data were compared considering the correlation. Forest and linked-receiver-operating-characteristic plots were drawn, and study heterogeneity was assessed using Q-test and Higgins-index. Publication bias was evaluated by Egger's test. A P-value <0.05 was considered statistically significant, except for heterogeneity (P < 0.10).

Results: The sensitivity for HCC did not differ significantly between the imaging-based diagnosis using EASL-criteria (61%; 95% CI, 50%-73%) and LR-5 (64%; 95% CI, 53%-76%; P = 0.165). The specificities were also not significantly different between EASL-criteria (92%; 95% CI, 89%-94%) and LR-5 (94%; 95% CI, 91%-96%; P = 0.257). In subgroup analysis, no statistically significant differences were identified in the pooled performances between the two criteria for observations ≥20 mm (sensitivity P = 0.065; specificity P = 0.343) or 10-19 mm (sensitivity P > 0.999; specificity P = 0.851). There was no publication bias for EASL (P = 0.396) and LI-RADS (P = 0.526).

Data conclusion: In the present meta-analysis of paired comparisons, the pooled sensitivities and specificities were not significantly different between 2018 EASL-criteria and LR-5 of LI-RADS for noninvasive-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
Roh, Yun Ho(노윤호)
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
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