LI-RADS 2018 beats version 2017 for diagnosing small HCCs

The updated LR-5 criteria for Liver Imaging Reporting and Data System (LI-RADS) version 2018 can improve sensitivity for diagnosing small hepatocellular carcinomas (HCC) compared to LI-RADS 2017.

Results of the study published July 16 in Radiology found a small drop in specificity for diagnosing small HCCs (10-19 millimeters) on gadoxetate disodium-enhanced MRI, but LI-RADS version 2018 resulted in a sensitivity of 76% compared to 11% for diagnosing such HCCs.

LI-RADS v2018 made several major changes to its algorithm, including updated LR-5 criteria, motivated largely by the goal of aligning the differing diagnostic systems for HCC and facilitating its integration into the American Association for the Study of Liver Diseases (AASLD) 2018 HCC clinical practice guidelines,” wrote Sang Min Lee, Hallym University Sacred Heart Hospital, Republic of Korea, and colleagues.

Additionally, the “0–19-mm observation with nonrim arterial phase hyperenhancement (APHE) and one additional major feature, including nonperipheral ‘washout’ and threshold growth, is now categorized as LR-5,” Lee et al. wrote, who pointed out such criteria were considered LR-4 under LI-RADS 2017.

For their retrospective study, the researchers reviewed 387 consecutive patients which included 234 HCCs confirmed using pathologic results from January 2013 to October 2015. All patients were considered high-risk for HCC with at least one observations of 10 mm or greater on gadoxetate disodium–enhanced MRI and no history of previous treatment for hepatic lesions.

In all 422 observations, LI-RADS version 2018 provided superior sensitivity (81%) compared to version 2017 (68%). And for diagnosing small HCCs, LI-RADS version 2018 far outperformed version 2017 in terms of sensitivity, albeit with a slightly lower specificity (94% compared to 99%, respectively).

Lee and colleagues noted that the decrease in specificity will result in an increase in false-positives, which could ultimately lead to more overtreatment of HCCs. This could also have a direct impact on liver transplants, but organizations such as the Organ Procurement and Transplantation Network, the authors noted, would be able to address such concerns.

There were a number of limitations to their study, including its single-center design and lack of standard reference. Also, only 18 of 143 benign lesions were confirmed at pathology which could have caused selection bias, the authors concluded.