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Diagnostic performance of CT versus MRI Liver Imaging Reporting and Data System category 5 for hepatocellular carcinoma: a systematic review and meta-analysis of comparative studies

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Abstract

Objective

To compare the performance of Liver Imaging Reporting and Data System category 5 (LR-5) for diagnosing HCC between CT and MRI using comparative studies.

Methods

The MEDLINE and EMBASE databases were searched from inception to April 21, 2021, to identify studies that directly compare the diagnostic performance of LR-5 for HCC between CT and MRI. A bivariate random-effects model was fitted to calculate the pooled per-observation sensitivity and specificity of LR-5 of each modality, and compare the pooled estimates of paired data. Subgroup analysis was performed according to the MRI contrast agent.

Results

Seven studies with 1145 observations (725 HCCs) were included in the final analysis. The pooled per-observation sensitivity of LR-5 for diagnosing HCC was higher using MRI (61%; 95% confidence interval [CI], 43–76%; I2 = 95%) than CT (48%; 95% CI, 31–65%; I2 = 97%) (p < 0.001). The pooled per-observation specificities of LR-5 did not show statistically significant difference between CT (96%; 95% CI, 92–98%; I2 = 0%) and MRI (93%; 95% CI, 88–96%; I2 = 16%) (p = 0.054). In the subgroup analysis, extracellular contrast agent–enhanced MRI showed significantly higher pooled per-observation sensitivity than gadoxetic acid–enhanced MRI for diagnosing HCC (73% [95% CI, 55–85%] vs. 55% [95% CI, 39–70%]; p = 0.007), without a significant difference in specificity (93% [95% CI, 80–98%] vs. 94% [95% CI, 87–97%]; p = 0.884).

Conclusions

The LR-5 of MRI showed significantly higher pooled per-observation sensitivity than CT for diagnosing HCC. The pooled per-observation specificities of LR-5 were comparable between the two modalities.

Key Points

• The pooled sensitivity of LR-5 using MRI was higher than that using CT (61% versus 48%), but the pooled specificities of LR-5 were not significantly different between CT and MRI (96% versus 93%).

• Subgroup analysis according to the MRI contrast media showed a significantly higher pooled per-observation sensitivity using ECA-enhanced MRI than with EOB-enhanced MRI (73% versus 55%), and comparable specificities (93% versus 94%).

• Although LI-RADS provides a common diagnostic algorithm for CT or MRI, the per-observation performance of LR-5 can be affected by the imaging modality as well as the MRI contrast agent.

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Abbreviations

CI:

Confidence interval

ECA:

Extracellular agent

EOB:

Gadoxetic acid

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LR-5:

Liver Imaging Reporting and Data System category 5

QUADAS–2:

Quality Assessment of Diagnostic Accuracy Studies–2

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Yeun-Yoon Kim, Sunyoung Lee & Jaeseung Shin

  2. Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea

    Won Jeong Son & Yun Ho Roh

  3. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jeong Ah Hwang

  4. Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea

    Ji Eun Lee

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  1. Yeun-Yoon Kim
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Correspondence to Sunyoung Lee.

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The scientific guarantor of this publication is Sunyoung Lee.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors (Won Jeong Son and Yun Ho Roh) have significant statistical expertise.

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Written informed consent was not required for this meta-analysis.

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Institutional Review Board approval was not required for this meta-analysis.

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Kim, YY., Lee, S., Shin, J. et al. Diagnostic performance of CT versus MRI Liver Imaging Reporting and Data System category 5 for hepatocellular carcinoma: a systematic review and meta-analysis of comparative studies. Eur Radiol 32, 6723–6729 (2022). https://doi.org/10.1007/s00330-022-08985-z

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  • DOI: https://doi.org/10.1007/s00330-022-08985-z

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