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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.

Publication ,  Journal Article
Kim, T-H; Woo, S; Joo, I; Bashir, MR; Park, M-S; Burke, LMB; Mendiratta-Lala, M; Do, RKG
Published in: Abdom Radiol (NY)
August 2021

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.

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Published In

Abdom Radiol (NY)

DOI

EISSN

2366-0058

Publication Date

August 2021

Volume

46

Issue

8

Start / End Page

3717 / 3728

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Retrospective Studies
  • Necrosis
  • Magnetic Resonance Imaging
  • Liver Neoplasms
  • Humans
  • Contrast Media
  • Carcinoma, Hepatocellular
  • Algorithms
 

Citation

APA
Chicago
ICMJE
MLA
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Kim, T.-H., Woo, S., Joo, I., Bashir, M. R., Park, M.-S., Burke, L. M. B., … Do, R. K. G. (2021). 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. Abdom Radiol (NY), 46(8), 3717–3728. https://doi.org/10.1007/s00261-021-03122-8
Kim, Tae-Hyung, Sungmin Woo, Ijin Joo, Mustafa R. Bashir, Mi-Suk Park, Lauren M. B. Burke, Mishal Mendiratta-Lala, and Richard K. G. Do. “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.Abdom Radiol (NY) 46, no. 8 (August 2021): 3717–28. https://doi.org/10.1007/s00261-021-03122-8.
Journal cover image

Published In

Abdom Radiol (NY)

DOI

EISSN

2366-0058

Publication Date

August 2021

Volume

46

Issue

8

Start / End Page

3717 / 3728

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Retrospective Studies
  • Necrosis
  • Magnetic Resonance Imaging
  • Liver Neoplasms
  • Humans
  • Contrast Media
  • Carcinoma, Hepatocellular
  • Algorithms