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Diagnostic performance of Liver Imaging Reporting and Data System treatment response algorithm: a systematic review and meta-analysis

  • Hepatobiliary-Pancreas
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Abstract

Objective

To systematically determine the accuracy of Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm for diagnosing the viability of hepatocellular carcinoma (HCC) treated with locoregional therapy (LRT).

Methods

Original studies reporting the diagnostic accuracy of LR-TR algorithm on dynamic contrast-enhanced computed tomography or magnetic resonance imaging (MRI) were identified in MEDLINE and EMBASE up to June 1, 2020. The meta-analytic summary sensitivity and specificity of LR-TR algorithm were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression analysis were performed to explore study heterogeneity.

Results

We found six studies reporting the accuracy of LR-TR viable category (601 observations in 453 patients). The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% confidence interval [CI], 39–81%; I2 = 88%) and 96% (95% CI, 91–99%; I2 = 76%), respectively. The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55–84%; I2 = 89%) and 87% (95% CI, 73–94% I2 = 80%), respectively. Studies which used only MRI showed a trend towards higher sensitivity (71% [95% CI, 46–88%]) with a comparable specificity (95% [95% CI, 86–99%]) of LR-TR viable category compared to the whole group. The type of reference standard and study design were significantly associated with study heterogeneity (p ≤ 0.01).

Conclusions

The LR-TR viable category had high specificity but suboptimal sensitivity for diagnosing the viability of HCC after LRT. Substantial study heterogeneity was noted, and it was significantly associated with the type of reference standard and study design.

Key Points

• The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% CI, 39–81%) and 96% (95% CI, 91–99%), respectively.

• The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55–84%) and 87% (95% CI, 73–94%), respectively.

• The type of reference standard and study design were the factors significantly influencing study heterogeneity (p ≤ 0.01).

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

CT:

Computed tomography

EASL:

European Association for the Study of the Liver

HCC:

Hepatocellular carcinoma

HSROC:

Hierarchical summary receiver operating characteristic

LI-RADS:

Liver Imaging Reporting and Data System

LRT:

Locoregional therapy

LR-TR:

LI-RADS treatment response

mRECIST:

modified Response Evaluation Criteria in Solid Tumors

MRI:

Magnetic resonance imaging

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea

    Seo Yeon Youn, Dong Hwan Kim, Bohyun Kim, Joon-Il Choi, Yu Ri Shin, Soon Nam Oh & Sung Eun Rha

  2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea

    Sang Hyun Choi

Authors
  1. Seo Yeon Youn
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  2. Dong Hwan Kim
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  3. Sang Hyun Choi
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  4. Bohyun Kim
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  5. Joon-Il Choi
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  6. Yu Ri Shin
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  7. Soon Nam Oh
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Corresponding author

Correspondence to Dong Hwan Kim.

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Guarantor

The scientific guarantor of this publication is Joon-Il Choi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because this study was meta-analysis.

Ethical approval

Institutional Review Board approval was not required because this study was meta-analysis.

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• Retrospective

• Meta-analysis

• Performed at one institution

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Youn, S.Y., Kim, D.H., Choi, S.H. et al. Diagnostic performance of Liver Imaging Reporting and Data System treatment response algorithm: a systematic review and meta-analysis. Eur Radiol 31, 4785–4793 (2021). https://doi.org/10.1007/s00330-020-07464-7

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  • DOI: https://doi.org/10.1007/s00330-020-07464-7

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