Abedrabbo Nicole, Lerner Emily, Lam Eric, Kadi Diana, Dawit Haben, van der Pol Christian, Salameh Jean-Paul, Naringrekar Haresh, Adamo Robert, Alabousi Mostafa, Levis Brooke, Tang An, Alhasan Ayman, Arvind Ashwini, Singal Amit, Allen Brian, Bartnik Krzysztof, Podgórska Joanna, Furlan Alessandro, Cannella Roberto, Dioguardi Burgio Marco, Cerny Milena, Choi Sang Hyun, Clarke Christopher, Jing Xiang, Kierans Andrea, Ronot Maxime, Rosiak Grzegorz, Jiang Hanyu, Song Ji Soo, Reiner Caecilia C, Joo Ijin, Kwon Heejin, Wang Wentao, Rao Sheng-Xiang, Diaz Telli Federico, Piñero Federico, Seo Nieun, Kang Hyo-Jin, Wang Jin, Min Ji Hye, Costa Andreu, McInnes Matthew, Bashir Mustafa
Duke University School of Medicine, Durham, NC, USA.
The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Abdom Radiol (NY). 2025 Apr;50(4):1533-1546. doi: 10.1007/s00261-024-04580-6. Epub 2024 Sep 27.
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.
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.
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).
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.
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.
肝脏影像报告和数据系统（LI-RADS）未考虑感兴趣观察对象之外的因素，如同时存在的LR-5观察结果。
通过个体参与者数据（IPD）荟萃分析，评估同时存在LR-5观察结果是否与LR-3或LR-4观察结果代表肝细胞癌（HCC）的概率差异相关。
检索了多个数据库，时间跨度为2014年1月至2023年2月，以查找使用LI-RADS v2014/2017/2018评估CT/MRI对HCC诊断准确性的研究。检索策略、研究选择和数据收集过程可在https://osf.io/rpg8x上找到。使用广义线性混合模型（GLMM），将各研究中的IPD进行汇总，并采用单阶段荟萃分析方法进行同步建模，以估计LR-3和LR-4观察结果在无和有同时存在的LR-5情况下对HCC诊断的阳性预测值（PPV）。使用综合参考标准和诊断准确性研究质量评估2（QUADAS-2）评估偏倚风险。
纳入了29项研究，共1456例患者的2591次观察结果（平均年龄59岁，1083例[74%]为男性）。1009例患者中的587/1960（29.9%）次LR-3观察结果同时存在LR-5。同时存在LR-5的LR-3观察结果的PPV与无LR-5的PPV无显著差异（45.4%对37.1%，p = 0.63）。447例患者中的264/631（41.8%）次LR-4观察结果同时存在LR-5。同时存在LR-5的LR-4观察结果的PPV与无同时存在LR-5的LR-4观察结果无显著差异（88.6%对69.5%，p = 0.08）。对低偏倚风险研究（n = 9）的敏感性分析与主要分析结果无差异。
同时存在LR-5与LR-3或LR-4观察结果对HCC诊断的PPV差异无显著关联, 支持当前的LI-RADS范式，即同步存在LR-5可能不会改变LR-3和LR-4观察结果的分类。
