| Description |
- Background: The Liver Imaging Reporting and Data System (LI-RADS) does not consider factors extrinsic to the observation of interest, such as concurrent LR-5 observations.
Purpose: To evaluate whether the presence of a concurrent LR-5 observation is associated with a difference in the probability that LR-3 or LR-4 observations represent HCC through an individual participant data (IPD) meta-analysis.
Methods: Multiple databases were searched from January 2014 to February 2023 for studies evaluating the diagnostic accuracy of CT/MRI for HCC using LI-RADS v2014/2017/2018. The search strategy, study selection, and data collection process can be found at https://osf.io/rpg8x. Using a generalized linear mixed model (GLMM), IPD were pooled across studies and modeled simultaneously with a one-stage meta-analysis approach to estimate positive predictive value (PPV) of LR-3 and LR-4 observations without and with concurrent LR-5 for the diagnosis of HCC. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).
Results: Twenty-nine studies comprising 2591 observations in 1456 patients (mean age 59 years, 1083 [74%] male) were included. Of 1960 LR-3 observations in 1009 patients, 29.9% (587) had concurrent LR-5. The PPV for LR-3 observations with concurrent LR-5 was not significdifferent from the PPV without LR-5 (45.4% vs 37.1%, p=0.63). For LR-4, there were 631 observations in 447 patients, of which 41.8% (n=264) had concurrent LR-5. The PPV for LR-4 observations with concurrent LR-5 was not significantly different from LR-4 observations without concurrent LR-5 (88.6% vs 69.5%, p=0.08). Sixty-nine percent (n=20/29) studies were at high risk of bias. A sensitivity analysis for low-risk of bias studies did not differ from the primary analysis.
Conclusion: The presence of concurrent LR-5 was not associated with differences in PPV for HCC in LR-3 or LR-4 observations. These results support the current LIRADS paradigm, wherein the presence of synchronous LR-5 should not alter the categorization of LR-3 and LR-4 observations.
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