Bridging the gap in hepatocellular carcinoma detection: evaluating LI-RADS with MRI

Diagnostic Accuracy of LI-RADS in HCC Detection

Abstract

 Objectives: This study aimed to determine diagnostic accuracy of the LI-RADS (Liver Imaging Reporting and Data System) using magnetic resonance imaging (MRI) for detecting Hepatocellular carcinoma (HCC) in cases of liver cirrhosis diagnosed to have hepatic nodules≤20 mm, using histopathology as the reference.

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Department of Radiology, Holy Family Hospital, Rawalpindi. Study duration was from 25-03-2024 till 24-01-2025

Patients and Methods: After ethical approval, 170 consecutive eligible patients underwent multiphasic gadoliniumenhanced abdominal MRI on a 1.5 Tesla system "(33 mT/m gradient)", with LI-RADS interpretation by a consultant radiologist. All patients also underwent ultrasound-guided percutaneous fine needle biopsy, and histopathology served as the gold standard. Data were analyzed using SPSS 20, with diagnostic performance assessed via a 2×2 contingency table, and stratification applied to evaluate the impact of effect modifiers on diagnostic accuracy.

Results: A total of 170 patients (53% males, 47% females) were included, with mean age 45.28±11.67 years, BMI 30.38±2.33 kg/m², cirrhosis duration 7.93±2.46 months, and nodule size 11.25±5.25 mm; HCC was identified in 60% by LI-RADS. Diagnostic performance showed sensitivity 60.78%, specificity 95.58%, PPV 95.38%, NPPV 61.90%, and accuracy 74.70%.

Stratified accuracy was similar by age (<40: 75.38%, >40: 73.53%) and sex (males 74.44%, females 75%), but higher with BMI >27 kg/m² (76.69% vs. 71.64%) and cirrhosis duration >10 months (83% vs. 70.94%); accuracy was 77.02% for nodules <10 mm and 72.91% for >10 mm. Overall, LI-RADS shows high specificity but moderate sensitivity, with better performance in higher BMI and longer cirrhosis duration.

Conclusion: This study demonstrates Li-RADS with MRI to have high diagnostic accuracy for detection of hepatocellular carcinoma. Standardization of reports of CT and MRI with LI-RADS improves consistency, reduces errors, and enhances patient management. It also supports nationwide data collection, enabling future research and AI-driven analysis in HCC diagnostics