Hepatocellular Carcinoma versus Other Hepatic Malignancy in Cirrhosis: Performance of LI-RADS Version 2018

Purpose To evaluate the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS)version2018for differentiating betweenhepatocellularcarcinoma(HCC) andother(hepatic)malignancy(OM) in patients with livercirrhosis. Materials and Methods From 2008 to 2017, 55 patients with untreated OM and livercirrhosiswere eligible for this retrospective case-control study (mean age, 58 years ± 10 [standard deviation] [range, 32-79 years], with 45 men [mean age, 58 years ± 11] and 10 women [mean age, 62 years ± 7]). Control subjects consisted of 165 treatment-naive patients with HCC and livercirrhosis(mean age, 58 years ± 10 [range, 29-80 years], with 134 men [mean age, 58 years ± 9] and 31 women [mean age, 59 years ± 11]). Two radiologists blinded to the final diagnosis independently determined the presence of LR-M features and major HCC features (non-rim arterial phase hyperenhancement, non-peripheral washout, and enhancing capsule). The diagnostic performances of each feature, the LR-M criteria (probably or definitely malignant, but not specific for HCC), and the LR-5 criteria (definitely HCC) were calculated and compared by using the generalized estimating equation method. Results Individual LR-M features had a sensitivity of 9%-71% and a specificity of 83%-97% for the diagnosis of OM. Major features of HCC had a sensitivity of 62%-83% and a specificity of 69%-89% for the diagnosis of HCC. The LR-M criteria had a sensitivity of 89% (95% confidence interval [CI]: 81%, 97%) for diagnosing OM, with a specificity of 48% (95% CI: 40%, 56%). The LR-5 criteria had a sensitivity of 74% (95% CI: 67%, 81%) for diagnosing HCC, with a specificity of 89% (95% CI: 81%, 97%). The accuracy of the LR-5 criteria was higher than that of the LR-M criteria (78% [95% CI: 72%, 83%] vs 58% [95% CI: 52%, 65%], P <. 001). Conclusion The LR-5 criteria as well as the LR-M criteria can effectively distinguishhepatocellularcarcinomafromotherhepaticmalignancyin patients with livercirrhosis. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Furlan in this issue.restrictio