Highlights
- •The 2014 version of LI-RADS does not outperform AASLD criteria for the non-invasive diagnosis of HCC <3 cm.
- •The rate of HCC decreases from LR-5 to LR-3.
- •LI-RADS offers a nodule-based evaluation of the risk of HCC.
- •The added-value of ancillary features is limited for the non-invasive diagnosis of small HCC.
Background & Aims
Non-invasive imaging is crucial for the early diagnosis and successful treatment of
hepatocellular carcinoma (HCC). Terminology and criteria for interpreting and reporting
imaging results must be standardized to optimize diagnosis. The aim of this study
was to prospectively compare the diagnostic accuracy of the American Association for
the Study of Liver Diseases (AASLD) and the 2014 version of Liver Imaging Reporting
and Data System (LI-RADS®) criteria for the non-invasive diagnosis of small HCC, and
to evaluate the diagnostic value of ancillary features used in the LI-RADS criteria.
Methods
Between April 2009 and April 2012, patients with cirrhosis and one to three 10–30 mm
nodules were enrolled and underwent computed tomography (CT) and magnetic resonance
(MR) imaging. The diagnostic accuracy of both the AASLD and the LI-RADS criteria were
determined based on their sensitivity, specificity, positive (PPV) and negative predictive
values (NPV).
Results
A total of 595 nodules were included (559 [341 HCC, 61%] with MR imaging and 529 [332
HCC, 63%] with CT). Overall, no (0%) LR-1 and LR-2, 44 (33%) and 47 (41%) LR-3, 50
(53%) and 54 (55%) LR-4, 244 (94%) and 222 (91%) LR-5 and 4 (67%) and 9 (82%) LR-5V
were HCC on MR imaging and CT, respectively. The sensitivity, specificity, PPV/NPV
of the AASLD score was 72.5%, 87.6%, 90.2%, and 66.9% for MR imaging, and 71.4%, 77.7%,
84.3%, 61.7% for CT, respectively. For the combination of LR-5V and LR-5 nodules these
measures were 72.5%, 89.9%, 91.9% and 67.5% on MRI and 66.9%, 88.3%, 90.9% and 63.3%
on CT, respectively. For the combination of LR-5V, LR-5 and LR-4 nodules they were
87.1%, 69.1%, 81.6% and 77.3% on MRI and 85.8%, 66%, 81% on 73.5% on CT, respectively.
Conclusion
The 2014 version of the LI-RADS is no more accurate than the AASLD score for the non-invasive
diagnosis of small HCC in high-risk patients, but it provides important and complementary
information on the probability of having HCC in high-risk patients, allowing for possible
changes in the management of these patients.
Lay summary
The 2014 version of Liver Imaging Reporting and Data System criteria does not outperform
the American Association for the Study of Liver Diseases criteria for the non-invasive
diagnosis of hepatocellular carcinoma (HCC) smaller than 3 cm. Liver Imaging Reporting
and Data System offers a nodule-based evaluation of the risk of HCC, allowing possible
changes in management in these patients. The added value of ancillary features appears
limited for the non-invasive diagnosis of small HCC.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 20, 2017
Accepted:
December 11,
2017
Received in revised form:
December 8,
2017
Received:
April 27,
2017
Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
