Diagnostic Performance of the 2018 EASL vs. LI‐RADS for Hepatocellular Carcinoma Using CT and MRI: A Systematic Review and Meta‐Analysis of Comparative Studies

Abstract

BackgroundHepatocellular carcinoma (HCC) can be diagnosed without pathologic confirmation in high‐risk patients. Therefore, it is necessary to compare current imaging criteria for noninvasive‐diagnosis of HCC.PurposeTo systematically compare performance of 2018 European Association for the Study of the Liver (EASL) criteria and Liver Imaging Reporting and Data System (LI‐RADS) for noninvasive‐diagnosis of HCC.Study TypeSystematic review and meta‐analysis.SubjectsEight studies with 2232 observations, including 1617 HCCs.Field Strength/Sequence1.5 T, 3.0 T/T2‐weighted, unenhanced T1‐weighted in‐/opposed‐phases, multiphase T1‐weighted imaging.AssessmentFollowing the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, two reviewers independently reviewed and extracted data, including patient characteristics, index test, reference standard and outcomes, from studies intraindividually comparing the sensitivities and specificities of 2018 EASL‐criteria and LR‐5 of LI‐RADS for HCC. Risk of bias and concerns regarding applicability were evaluated using QUADAS‐2 tool. Subgroup analysis was performed based on observation size (≥20 mm, 10–19 mm).Statistical TestsBivariate random‐effects model to calculate pooled per‐observation sensitivity and specificity of both imaging criteria, and pooled estimates of intraindividual paired data were compared considering the correlation. Forest and linked‐receiver‐operating‐characteristic plots were drawn, and study heterogeneity was assessed using Q‐test and Higgins‐index. Publication bias was evaluated by Egger's test. A P‐value <0.05 was considered statistically significant, except for heterogeneity (P < 0.10).ResultsThe sensitivity for HCC did not differ significantly between the imaging‐based diagnosis using EASL‐criteria (61%; 95% CI, 50%–73%) and LR‐5 (64%; 95% CI, 53%–76%; P = 0.165). The specificities were also not significantly different between EASL‐criteria (92%; 95% CI, 89%–94%) and LR‐5 (94%; 95% CI, 91%–96%; P = 0.257). In subgroup analysis, no statistically significant differences were identified in the pooled performances between the two criteria for observations ≥20 mm (sensitivity P = 0.065; specificity P = 0.343) or 10–19 mm (sensitivity P > 0.999; specificity P = 0.851). There was no publication bias for EASL (P = 0.396) and LI‐RADS (P = 0.526).Data ConclusionIn the present meta‐analysis of paired comparisons, the pooled sensitivities and specificities were not significantly different between 2018 EASL‐criteria and LR‐5 of LI‐RADS for noninvasive‐diagnosis of HCC.Evidence Level3.Technical EfficacyStage 2.