LR-5 在 2018 版 LI-RADS 与修订版 LI-RADS 用于肝细胞癌诊断的个体参与者数据汇总分析。
Individual Participant Data Meta-Analysis of LR-5 in LI-RADS Version 2018 versus Revised LI-RADS for Hepatocellular Carcinoma Diagnosis.
机构信息
From the Department of Radiology, Duke University School of Medicine, Durham, NC (S.M.G.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J., B.S.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (C.B.v.d.P.); Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada (J.P.S.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (E.L.); Faculty of Medicine at The University of Ottawa, Ottawa, Ontario, Canada (R.G.A.); Departments of Radiology and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada (M.D.F.M.); The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada (M.D.F.M.); Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (A.F.C.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (A.T.); Department of Radiology, College of Medicine, Taibah University, Medina, Saudi Arabia (A.S.A.); Department of Radiology, King Faisal Specialist Hospital and Research Centre, Medina, Saudi Arabia (A.S.A.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland (C.S.R.); Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (C.C.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (M.C.); Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (J.W.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.H.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F., D.R.L.); Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea (I.J.); Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China (Z.K.); Weill Cornell Medical Center, New York, NY (A.S.K.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, South Korea (S.Y.K.); Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Seo-gu, Busan, South Korea (H.K.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy and Université Paris Cité, CRI UMR 1149, Paris, France (M.R.); Second Radiology Department, Warsaw Medical University, Warsaw, Poland (J.P., G.R.); Department of Radiology, Jeonbuk National University Medical School and Hospital, Deokjin-gu, Jeonju, Jeonbuk, South Korea (J.S.S.); Departments of Radiology and Medicine, Duke University Medical Center, 40 Duke Medicine Cir, Durham, NC, 27710 (M.R.B.); Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (M.R.B.).
出版信息
Radiology. 2023 Dec;309(3):e231656. doi: 10.1148/radiol.231656.
Background A simplification of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 (v2018), revised LI-RADS (rLI-RADS), has been proposed for imaging-based diagnosis of hepatocellular carcinoma (HCC). Single-site data suggest that rLI-RADS category 5 (rLR-5) improves sensitivity while maintaining positive predictive value (PPV) of the LI-RADS v2018 category 5 (LR-5), which indicates definite HCC. Purpose To compare the diagnostic performance of LI-RADS v2018 and rLI-RADS in a multicenter data set of patients at risk for HCC by performing an individual patient data meta-analysis. Materials and Methods Multiple databases were searched for studies published from January 2014 to January 2022 that evaluated the diagnostic performance of any version of LI-RADS at CT or MRI for diagnosing HCC. An individual patient data meta-analysis method was applied to observations from the identified studies. Quality Assessment of Diagnostic Accuracy Studies version 2 was applied to determine study risk of bias. Observations were categorized according to major features and either LI-RADS v2018 or rLI-RADS assignments. Diagnostic accuracies of category 5 for each system were calculated using generalized linear mixed models and compared using the likelihood ratio test for sensitivity and the Wald test for PPV. Results Twenty-four studies, including 3840 patients and 4727 observations, were analyzed. The median observation size was 19 mm (IQR, 11-30 mm). rLR-5 showed higher sensitivity compared with LR-5 (70.6% [95% CI: 60.7, 78.9] vs 61.3% [95% CI: 45.9, 74.7]; < .001), with similar PPV (90.7% vs 92.3%; = .55). In studies with low risk of bias ( = 4; 1031 observations), rLR-5 also achieved a higher sensitivity than LR-5 (72.3% [95% CI: 63.9, 80.1] vs 66.9% [95% CI: 58.2, 74.5]; = .02), with similar PPV (83.1% vs 88.7%; = .47). Conclusion rLR-5 achieved a higher sensitivity for identifying HCC than LR-5 while maintaining a comparable PPV at 90% or more, matching the results presented in the original rLI-RADS study. © RSNA, 2023 . See also the editorial by Sirlin and Chernyak in this issue.
背景
简化的 Liver Imaging Reporting and Data System（LI-RADS）版本 2018（v2018），即修订的 LI-RADS（rLI-RADS），已被提议用于基于影像学的肝细胞癌（HCC）诊断。单站点数据表明，rLI-RADS 类别 5（rLR-5）提高了敏感性，同时保持了 LI-RADS v2018 类别 5（LR-5）的阳性预测值（PPV），LR-5 表示明确的 HCC。目的：通过进行个体患者数据荟萃分析，比较 LI-RADS v2018 和 rLI-RADS 在 HCC 风险患者的多中心数据集的诊断性能。材料与方法：检索了从 2014 年 1 月至 2022 年 1 月发表的评估 CT 或 MRI 上任何版本 LI-RADS 用于诊断 HCC 的诊断性能的研究的多个数据库。应用个体患者数据荟萃分析方法分析了从确定的研究中观察到的数据。应用诊断准确性研究质量评估 2 版来确定研究的偏倚风险。根据主要特征和 LI-RADS v2018 或 rLI-RADS 分类对观察结果进行分类。使用广义线性混合模型计算每个系统的 5 类的诊断准确性，并使用似然比检验进行敏感性比较，使用 Wald 检验进行 PPV 比较。结果：共分析了 24 项研究，包括 3840 名患者和 4727 项观察结果。观察值的中位数为 19mm（IQR，11-30mm）。rLR-5 的敏感性高于 LR-5（70.6%[95%CI：60.7%，78.9%]比 61.3%[95%CI：45.9%，74.7%]；<.001），但 PPV 相似（90.7%比 92.3%；=.55）。在偏倚风险低的研究中（=4；1031 项观察结果），rLR-5 的敏感性也高于 LR-5（72.3%[95%CI：63.9%，80.1%]比 66.9%[95%CI：58.2%，74.5%]；=.02），PPV 相似（83.1%比 88.7%；=.47）。结论：rLR-5 对识别 HCC 的敏感性高于 LR-5，同时保持了 90%或更高的可比 PPV，与原始 rLI-RADS 研究中的结果相匹配。©2023RSNA。请同时参阅本期 Sirlin 和 Chernyak 的社论。
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