Diagnostic Performance of Liver Imaging Reporting and Data System Version 2017 Versus Version 2018 for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Comparative Studies.

Abstract

BACKGROUND\nThe Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging in patients at risk for hepatocellular carcinoma (HCC).\n\n\nPURPOSE\nTo systematically compare the performance of computed tomography (CT)/MRI LI-RADS category 5 (LR-5) for diagnosing HCC between versions 2017 and 2018.\n\n\nSTUDY TYPE\nSystematic review and meta-analysis.\n\n\nSUBJECTS\nSix articles with 1181 lesions.\n\n\nFIELD STRENGTH/SEQUENCE\n1.5\u2009T and 3.0\u2009T.\n\n\nASSESSMENT\nData extraction was independently performed by two reviewers who identified and reviewed articles comparing the performance of LR-5 for diagnosing HCC between CT/MRI LI-RADS versions 2017 and 2018. Study and patient characteristics, index test characteristics, 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.\n\n\nSTATISTICAL TESTS\nBivariate random-effects models were used to calculate the pooled per-observation sensitivity and specificity of LR-5 using both versions. The summary receiver operating characteristic curves were plotted. Meta-regression analysis was performed to explore heterogeneity. A P-value <0.05 was considered to be statistically significant for all analyses other than heterogeneity, where the significance threshold was 0.1.\n\n\nRESULTS\nThe pooled per-observation sensitivity of LR-5 for diagnosing HCC did not show statistically significant difference between versions 2017 (60%; 95% confidence interval [CI], 49%-70%) and 2018 (67%; 95% CI, 56%-76%; P = 0.381). The pooled per-observation specificities of LR-5 were not significantly different between versions 2017 (92%; 95% CI, 90%-95%) and 2018 (91%; 95% CI, 88%-93%; P = 0.332). Meta-regression analyses revealed that the most common underlying liver disease (hepatitis B or hepatitis C) was a significant factor contributing to the heterogeneity of sensitivities among studies for both versions.\n\n\nDATA CONCLUSION\nIn this meta-analysis using intraindividual paired comparisons, the pooled sensitivity and pooled specificity of LR-5 were not significantly different between 2017 and 2018 LI-RADS versions.\n\n\nLEVEL OF EVIDENCE\n3 TECHNICAL EFFICACY: Stage 2.