LI-RADS treatment response algorithm for detecting incomplete necrosis in hepatocellular carcinoma after locoregional treatment: a systematic review and meta-analysis using individual patient data.

Journal Article (Journal Article;Systematic Review)

PURPOSE: To perform a systematic review and meta-analysis using individual patient data to investigate the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) Treatment Response (TR) algorithm for detecting incomplete necrosis on pathology. METHODS: PubMed and EMBASE were searched from Jan 1, 2017 until October 14, 2020. Studies reporting diagnostic accuracy of LI-RADS TR algorithm on CT or MRI for detecting incomplete necrosis on pathology as a reference standard were included. Sensitivity and specificity were pooled using random-effects model. Subgroup analyses were performed for locoregional treatment (LRT) type and imaging modality. RESULTS: Six studies (393 patients, 534 lesions) were included. Pooled sensitivity was 0.56 (95% confidence interval [CI] 0.43-0.69) and specificity was 0.91 (95%CI 0.84-0.96). Pooled sensitivity was highest using arterial phase hyperenhancement (APHE) (0.67 [95%CI 0.51-0.81]), followed by washout (0.43 [95%CI 0.26-0.62]) and enhancement similar to pretreatment (0.24 [95%CI 0.15-0.36]). Among lesions with incomplete necrosis, 2% (95%CI 0.00-0.05) manifested as washout but no APHE; 0% (95% CI 0.00-0.02) as enhancement similar to pretreatment without both APHE and washout. Pooled sensitivity was lower after ablation than embolization (0.42 [95%CI, 0.28-0.57] vs. 0.65 [95%CI, 0.53-0.77], p = 0.033). MRI and CT were comparable (p = 0.783 and 0.290 for sensitivity and specificity). CONCLUSIONS: LI-RADS TR algorithm shows moderate sensitivity and high specificity for detecting incomplete necrosis after LRT. APHE is the dominant criterion, a washout contributes to small but meaningful extent, while the contribution of enhancement similar to pretreatment may be negligible. LRT type may affect performance of the algorithm.

Full Text

Duke Authors

Cited Authors

  • Kim, T-H; Woo, S; Joo, I; Bashir, MR; Park, M-S; Burke, LMB; Mendiratta-Lala, M; Do, RKG

Published Date

  • August 2021

Published In

Volume / Issue

  • 46 / 8

Start / End Page

  • 3717 - 3728

PubMed ID

  • 34027566

Electronic International Standard Serial Number (EISSN)

  • 2366-0058

Digital Object Identifier (DOI)

  • 10.1007/s00261-021-03122-8


  • eng

Conference Location

  • United States