European Radiology

, Volume 28, Issue 5, pp 2038–2046 | Cite as

Diagnostic accuracy of prospective application of the Liver Imaging Reporting and Data System (LI-RADS) in gadoxetate-enhanced MRI

  • Yeun-Yoon Kim
  • Chansik An
  • Sungwon Kim
  • Myeong-Jin KimEmail author



To evaluate the diagnostic performance of the LI-RADS (v2014) on gadoxetate-enhanced MRI prospectively applied in actual practice.


We retrospectively reviewed the prospectively written radiology reports of 143 treatment-naïve at-risk patients who underwent gadoxetate-enhanced liver MRI from January to December 2014, and identified 202 hepatic observations categorized using the LI-RADS. The diagnostic performances of LI-RADS categories for hepatocellular carcinoma (HCC) and hepatic malignancy were calculated.


Twenty (69.0 %) of 29 LR-4, 73 (97.3 %) of 75 LR-5, and all of five (100 %) LR-5V observations were HCCs. The remaining two (2.7 %) LR-5 observations were combined hepatocellular-cholangiocarcinomas, while 10 (76.9 %) of 13 LR-M observations were HCCs. The sensitivity and specificity of LR-5/5V for HCC were 60.5 % and 97.3 %, respectively. Including LR-M in the diagnostic criteria for HCC increased sensitivity (68.2 %, p = 0.002) but decreased specificity without statistical significance (93.2 %, p = 0.154). LR-5/5V/M yielded sensitivity of 68.9 % and specificity of 100.0 % for hepatic malignancy.


LI-RADS v2014 was successfully applied on gadoxetate-enhanced MRI in clinical practice. LR-5/5V was the most specific diagnostic measure for HCC, but most LR-M observations were HCCs and a considerable portion of non-HCC malignancies were categorized as LR-4 or LR-5.

Key Points

LR-5/5V provided a highly specific diagnosis for HCC.

Half of non-HCC malignancies were categorized as LR-4 or LR-5.

The majority of LR-M observations were finally diagnosed as HCCs.

More sensitive diagnosis of HCC was feasible with LR-5/5V/M on gadoxetate-enhanced MRI.

Observations in either LR-5/5V or LR-M categories were definitely malignant.


Liver Magnetic resonance imaging Gadolinium DTPA disodium salt Diagnosis Sensitivity and Specificity 



Hepatocellular carcinoma


Liver Imaging Reporting and Data System


LI-RADS category


Magnetic resonance imaging



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

Compliance with ethical standards


The scientific guarantor of this publication is Myeong-Jin Kim.

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

Ha Yan Kim, M.S. in statistics, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• performed at one institution


  1. 1.
    Mitchell DG, Bruix J, Sherman M, Sirlin CB (2015) LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology 61:1056–1065CrossRefPubMedGoogle Scholar
  2. 2.
    American College of Radiology (2017) Liver Imaging reporting and data system version 2017. Available via Accessed 1 Jul 2017
  3. 3.
    Petruzzi N, Mitchell D, Guglielmo F, O'Kane P, Deshmukh S, Roth C, Shortt C, Balfour S, Parker L (2013) Hepatocellular carcinoma likelihood on MRI exams: evaluation of a standardized categorization system. Acad Radiol 20:694–698CrossRefPubMedGoogle Scholar
  4. 4.
    Darnell A, Forner A, Rimola J, Reig M, Garcia-Criado A, Ayuso C, Bruix J (2015) Liver Imaging Reporting and Data System with MR Imaging: Evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275:698–707CrossRefPubMedGoogle Scholar
  5. 5.
    Hope TA, Fowler KJ, Sirlin CB, Costa EA, Yee J, Yeh BM, Heiken JP (2015) Hepatobiliary agents and their role in LI-RADS. Abdom Imaging 40:613–625CrossRefPubMedGoogle Scholar
  6. 6.
    American College of Radiology (2014) Liver imaging reporting and data system version 2014. Available via Accessed 19 Nov 2016
  7. 7.
    Joo I, Lee JM, Lee SM, Lee JS, Park JY, Han JK (2016) Diagnostic accuracy of liver imaging reporting and data system (LI-RADS) v2014 for intrahepatic mass-forming cholangiocarcinomas in patients with chronic liver disease on gadoxetic acid-enhanced MRI. J Magn Reson Imaging 44:1330–1338CrossRefPubMedGoogle Scholar
  8. 8.
    Choi SH, Byun JH, Kim SY, Lee SJ, Won HJ, Shin YM, Kim PN (2016) Liver Imaging Reporting and Data System v2014 with gadoxetate disodium-enhanced magnetic resonance imaging: Validation of LI-RADS category 4 and 5 criteria. Investig Radiol 51:483–490CrossRefGoogle Scholar
  9. 9.
    Chen N, Motosugi U, Morisaka H, Ichikawa S, Sano K, Ichikawa T, Matsuda M, Fujii H, Onishi H (2016) Added value of a gadoxetic acid-enhanced hepatocyte-phase image to the LI-RADS system for diagnosing hepatocellular carcinoma. Magn Reson Med Sci 15:49–59CrossRefPubMedGoogle Scholar
  10. 10.
    Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF (2015) STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. Radiology 277:826–832CrossRefPubMedGoogle Scholar
  11. 11.
    Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRefGoogle Scholar
  13. 13.
    Feuerlein S, Boll DT, Gupta RT, Ringe KI, Marin D, Merkle EM (2011) Gadoxetate disodium–enhanced hepatic MRI: dose-dependent contrast dynamics of hepatic parenchyma and portal vein. AJR Am J Roentgenol 196:W18–W24CrossRefPubMedGoogle Scholar
  14. 14.
    Vogl TJ, Kümmel S, Hammerstingl R, Schellenbeck M, Schumacher G, Balzer T, Schwarz W, Müller PK, Bechstein WO, Mack MG, Söllner O, Felix R (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67CrossRefPubMedGoogle Scholar
  15. 15.
    Wells ML, Venkatesh SK, Chandan VS, Fidler JL, Fletcher JG, Johnson GB, Hough DM, Roberts LR (2015) Biphenotypic hepatic tumors: imaging findings and review of literature. Abdom Imaging 40:2293–2305CrossRefPubMedGoogle Scholar
  16. 16.
    Fowler KJ, Sheybani A, Parker RA 3rd, Doherty S, Brunt ME, Chapman WC, Menias CO (2013) Combined hepatocellular and cholangiocarcinoma (biphenotypic) tumors: imaging features and diagnostic accuracy of contrast-enhanced CT and MRI. AJR Am J Roentgenol 201:332–339CrossRefPubMedGoogle Scholar
  17. 17.
    Potretzke TA, Tan BR, Doyle MB, Brunt EM, Heiken JP, Fowler KJ (2016) Imaging features of biphenotypic primary liver carcinoma (hepatocholangiocarcinoma) and the potential to mimic hepatocellular carcinoma: LI-RADS analysis of CT and MRI features in 81 cases. AJR Am J Roentgenol 207:25–31CrossRefPubMedGoogle Scholar
  18. 18.
    International Agency for Research on Cancer (2013) GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon. Available via Accessed 6 Aug 2017
  19. 19.
    Korean Society of Abdominal Radiology (2017) Diagnosis of hepatocellular carcinoma with gadoxetic acid-enhanced MRI: 2016 consensus recommendations of the Korean Society of Abdominal Radiology. Korean J Radiol 18:427–443CrossRefGoogle Scholar
  20. 20.
    Choi SH, Byun JH, Lim YS, Yu E, Lee SJ, Kim SY, Won HJ, Shin YM, Kim PN (2016) Diagnostic criteria for hepatocellular carcinoma 3 cm with hepatocyte-specific contrast-enhanced magnetic resonance imaging. J Hepatol 64:1099–1107CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Yeun-Yoon Kim
    • 1
  • Chansik An
    • 1
  • Sungwon Kim
    • 1
  • Myeong-Jin Kim
    • 1
    Email author
  1. 1.Department of Radiology and Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulKorea

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