Impact of the Liver Imaging Reporting and Data System on Research Studies of Diagnosing Hepatocellular Carcinoma Using MRI

Yura Ahn; Sang Hyun Choi; Jong Keon Jang; So Yeon Kim; Ju Hyun Shim; Seung Soo Lee; Jae Ho Byun

doi:10.3348/kjr.2021.0393

Impact of the Liver Imaging Reporting and Data System on Research Studies of Diagnosing Hepatocellular Carcinoma Using MRI

Korean J Radiol. 2022 May;23(5):529-538. doi: 10.3348/kjr.2021.0393. Epub 2022 Mar 8.

Authors

Yura Ahn¹, Sang Hyun Choi², Jong Keon Jang¹, So Yeon Kim¹, Ju Hyun Shim³, Seung Soo Lee¹, Jae Ho Byun¹

Affiliations

¹ Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
² Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. edwardchoi83@gmail.com.
³ Department of Gastroenterology, Liver Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Abstract

Objective: Since its introduction in 2011, the CT/MRI diagnostic Liver Imaging Reporting and Data System (LI-RADS) has been updated in 2014, 2017, and 2018. We evaluated the impact of CT/MRI diagnostic LI-RADS on liver MRI research methodology for the diagnosis of hepatocellular carcinoma (HCC).

Materials and methods: The MEDLINE, EMBASE, and Cochrane databases were searched for original articles reporting the diagnostic performance of liver MRI for HCC between 2011 and 2019. The MRI techniques, image analysis methods, and diagnostic criteria for HCC used in each study were investigated. The studies were classified into three groups according to the year of publication (2011-2013, 2014-2016, and 2017-2019). We compared the percentage of studies adopting MRI techniques recommended by LI-RADS, image analysis methods in accordance with the lexicon defined in LI-RADS, and diagnostic criteria endorsed by LI-RADS. We compared the pooled sensitivity and specificity between studies that used the LI-RADS and those that did not.

Results: This systematic review included 179 studies. The percentages of studies using imaging techniques recommended by LI-RADS were 77.8% for 2011-2013, 85.7% for 2014-2016, and 84.2% for 2017-2019, with no significant difference (p = 0.951). After the introduction of LI-RADS, the percentages of studies following the LI-RADS lexicon were 0.0%, 18.4%, and 56.6% in the respective periods (p < 0.001), while the percentages of studies using the LI-RADS diagnostic imaging criteria were 0.0%, 22.9%, and 60.7%, respectively (p < 0.001). Studies that did not use the LI-RADS and those that used the LI-RADS version 2018 showed no significant difference in sensitivity and specificity (86.3% vs. 77.7%, p = 0.102 and 91.4% vs. 89.9%, p = 0.770, respectively), with some difference in heterogeneity (I² = 94.3% vs. 86.7% in sensitivity and I² = 86.6% vs. 53.2% in specificity).

Conclusion: LI-RADS imparted significant changes in the image analysis methods and diagnostic criteria used in liver MRI research for the diagnosis of HCC.

Keywords: Hepatocellular carcinoma; Liver; Liver imaging reporting and data system; Magnetic resonance imaging; Systematic review.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Hepatocellular* / diagnostic imaging
Contrast Media
Humans
Liver
Liver Neoplasms* / diagnostic imaging
Magnetic Resonance Imaging / methods
Research Design
Retrospective Studies
Sensitivity and Specificity

Substances

Contrast Media