Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis

Nicole Abedrabbo^#¹, Emily Lerner^#¹, Eric Lam², Diana Kadi¹, Haben Dawit³, Christian van der Pol⁴, Jean-Paul Salameh², Haresh Naringrekar⁵, Robert Adamo⁶, Mostafa Alabousi⁷, Brooke Levis⁸, An Tang⁹, Ayman Alhasan¹⁰, Ashwini Arvind¹¹, Amit Singal¹², Brian Allen¹, Krzysztof Bartnik¹³, Joanna Podgórska¹³, Alessandro Furlan¹⁴, Roberto Cannella¹⁵, Marco Dioguardi Burgio¹⁶, Milena Cerny⁹, Sang Hyun Choi¹⁷, Christopher Clarke¹⁸, Xiang Jing¹⁹, Andrea Kierans²⁰, Maxime Ronot¹⁶, Grzegorz Rosiak¹³, Hanyu Jiang²¹, Ji Soo Song²², Caecilia C Reiner²³, Ijin Joo²⁴, Heejin Kwon²⁵, Wentao Wang²⁶, Sheng-Xiang Rao²⁶, Federico Diaz Telli²⁷, Federico Piñero²⁸, Nieun Seo²⁹, Hyo-Jin Kang²⁴, Jin Wang³⁰, Ji Hye Min³¹, Andreu Costa³², Matthew McInnes², Mustafa Bashir³³

Affiliations

¹ Duke University School of Medicine, Durham, NC, USA.
² The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ University of Toronto, Toronto, Canada.
⁴ Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
⁵ Thomas Jefferson University, Philadelphia, USA.
⁶ University of Ottawa, Ottawa, Canada.
⁷ McMaster University, Hamilton, Canada.
⁸ Jewish General Hospital, Montreal, Canada.
⁹ University of Montreal, Montreal, Canada.
¹⁰ Taibah University, Medina, Saudi Arabia.
¹¹ The University of Texas Southwestern Medical Center, Dallas, USA.
¹² Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹³ Medical University of Warsaw, Warsaw, Poland.
¹⁴ University of Pittsburgh, Pittsburgh, USA.
¹⁵ Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
¹⁶ Université Paris Cité, Paris, France.
¹⁷ University of Ulsan, Ulsan, Republic of Korea.
¹⁸ Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁹ Tianjin Third Central Hospital, Tianjin, China.
²⁰ Weill Cornell Medical Center, New York, NY, USA.
²¹ West China Hospital of Sichuan University, Chengdu, China.
²² Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
²³ University Hospital of Zurich, Zurich, Switzerland.
²⁴ Seoul National University Hospital, Seoul, Republic of Korea.
²⁵ Dong-A University Hospital, Busan, Republic of Korea.
²⁶ Zhongshan Hospital, Fudan University, Shanghai, China.
²⁷ Images and Diagnosis Department, Universidad Austral, Buenos Aires, Argentina.
²⁸ Hepatology and Liver Transplant Unit, Universidad Austral, Buenos Aires, Argentina.
²⁹ Yonsei University Health System, Seoul, Republic of Korea.
³⁰ Sun Yat-sen University, Guangzhou, China.
³¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
³² Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
³³ Duke University School of Medicine, Durham, NC, USA. mustafa.bashir@duke.edu.

^# Contributed equally.

PMID: 39333410
DOI: 10.1007/s00261-024-04580-6

Meta-Analysis

Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis

Nicole Abedrabbo et al. Abdom Radiol (NY). 2025 Apr.

. 2025 Apr;50(4):1533-1546.

doi: 10.1007/s00261-024-04580-6. Epub 2024 Sep 27.

Authors

Affiliations

¹ Duke University School of Medicine, Durham, NC, USA.
² The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ University of Toronto, Toronto, Canada.
⁴ Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
⁵ Thomas Jefferson University, Philadelphia, USA.
⁶ University of Ottawa, Ottawa, Canada.
⁷ McMaster University, Hamilton, Canada.
⁸ Jewish General Hospital, Montreal, Canada.
⁹ University of Montreal, Montreal, Canada.
¹⁰ Taibah University, Medina, Saudi Arabia.
¹¹ The University of Texas Southwestern Medical Center, Dallas, USA.
¹² Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹³ Medical University of Warsaw, Warsaw, Poland.
¹⁴ University of Pittsburgh, Pittsburgh, USA.
¹⁵ Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
¹⁶ Université Paris Cité, Paris, France.
¹⁷ University of Ulsan, Ulsan, Republic of Korea.
¹⁸ Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁹ Tianjin Third Central Hospital, Tianjin, China.
²⁰ Weill Cornell Medical Center, New York, NY, USA.
²¹ West China Hospital of Sichuan University, Chengdu, China.
²² Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
²³ University Hospital of Zurich, Zurich, Switzerland.
²⁴ Seoul National University Hospital, Seoul, Republic of Korea.
²⁵ Dong-A University Hospital, Busan, Republic of Korea.
²⁶ Zhongshan Hospital, Fudan University, Shanghai, China.
²⁷ Images and Diagnosis Department, Universidad Austral, Buenos Aires, Argentina.
²⁸ Hepatology and Liver Transplant Unit, Universidad Austral, Buenos Aires, Argentina.
²⁹ Yonsei University Health System, Seoul, Republic of Korea.
³⁰ Sun Yat-sen University, Guangzhou, China.
³¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
³² Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
³³ Duke University School of Medicine, Durham, NC, USA. mustafa.bashir@duke.edu.

^# Contributed equally.

PMID: 39333410
DOI: 10.1007/s00261-024-04580-6

Abstract

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 hepatocellular carcinoma (HCC) through an individual participant data (IPD) meta-analysis.

Methods: Multiple databases were searched from 1/2014 to 2/2023 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. 587/1960 (29.9%) LR-3 observations in 1009 patients had concurrent LR-5. The PPV for LR-3 observations with concurrent LR-5 was not significantly different from the PPV without LR-5 (45.4% vs 37.1%, p = 0.63). 264/631 (41.8%) LR-4 observations in 447 patients 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). A sensitivity analysis for low-risk of bias studies (n = 9) did not differ from the primary analysis.

Conclusion: The presence of concurrent LR-5 was not significantly associated with differences in PPV for HCC in LR-3 or LR-4 observations, supporting the current LI-RADS paradigm, wherein the presence of synchronous LR-5 may not alter the categorization of LR-3 and LR-4 observations.

Keywords: Concurrent; Hepatocellular carcinoma; LI-RADS; LR-3; LR-4; Positive predictive value.

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Conflict of interest statement

Declarations. Competing interest: The authors declare no competing interests.

References

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Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis

Affiliations

Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical