Adamo Robert G, Lam Eric, Salameh Jean-Paul, van der Pol Christian B, Goins Stacy M, Dawit Haben, Costa Andreu F, Levis Brooke, Singal Amit G, Chernyak Victoria, Sirlin Claude B, Bashir Mustafa R, Tang An, Alhasan Ayman, Allen Brian C, Reiner Caecilia S, Clarke Christopher, Ludwig Daniel R, Cerny Milena, Wang Jin, Hyun Choi Sang, Fraum Tyler J, Song Bin, Joo Ijin, Yeon Kim So, Kwon Heejin, Jiang Hanyu, Kang Hyo-Jin, Kierans Andrea S, Kim Yeun-Yoon, Ronot Maxime, Podgórska Joanna, Rosiak Grzegorz, Soo Song Ji, McInnes Matthew D F
Faculty of Medicine at The University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Can Assoc Radiol J. 2025 Aug;76(3):466-476. doi: 10.1177/08465371241306297. Epub 2024 Dec 29.
Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. To evaluate whether the association between HCC risk factors and each CT/MRI LI-RADS major feature differs among individuals at-risk for HCC. Databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched from 2014 to 2022. Individual participant data (IPD) were extracted from studies evaluating HCC diagnosis using CT/MRI LI-RADS and reporting HCC risk factors. IPD from studies were pooled and modelled with one-stage meta-regressions. Interactions were assessed between major features and HCC risk factors, including age, sex, cirrhosis, chronic hepatitis B virus (HBV), and study location. A mixed effects model that included the major features, as well as separate models that included interactions between each risk factor and each major feature, were fit. Differences in interactions across levels of each risk factor were calculated using adjusted odds-ratios (ORs), 95% confidence-intervals (CI), and -tests. Risk of bias was assessed using QUADAS-2. (Protocol: https://osf.io/tdv7j/). Across 23 studies (2958 patients and 3553 observations), the associations between LI-RADS major features and HCC were consistent across several HCC risk factors (-value range: .09-.99). A sensitivity analysis among the 4 studies with a low risk of bias did not differ from the primary analysis. The association between CT/MRI LI-RADS major features and HCC risk factors do not significantly differ in individuals at-risk for HCC. These findings suggest that CT/MR LI-RADS should be applied to all patients considered at risk by LI-RADS without modification or exclusions, regardless of the presence or absence of the risk factors evaluated in this study.
指南表明，肝脏影像报告和数据系统（LI-RADS）可能不适用于某些肝细胞癌（HCC）风险人群。然而，缺乏评估HCC风险因素与LI-RADS主要特征之间关联的数据。为了评估HCC风险因素与每个CT/MRI LI-RADS主要特征之间的关联在HCC风险个体中是否存在差异。检索了2014年至2022年的数据库（MEDLINE、Embase、Cochrane对照试验中央注册库和Scopus）。从评估使用CT/MRI LI-RADS进行HCC诊断并报告HCC风险因素的研究中提取个体参与者数据（IPD）。将来自研究的IPD进行汇总，并通过单阶段meta回归进行建模。评估主要特征与HCC风险因素之间的相互作用，包括年龄、性别、肝硬化、慢性乙型肝炎病毒（HBV）和研究地点。拟合了一个包含主要特征的混合效应模型，以及包含每个风险因素与每个主要特征之间相互作用的单独模型。使用调整后的比值比（OR）、95%置信区间（CI）和检验计算每个风险因素水平上相互作用的差异。使用QUADAS-2评估偏倚风险。（方案：https://osf.io/tdv7j/）。在23项研究（2958例患者和3553次观察）中，LI-RADS主要特征与HCC之间的关联在多个HCC风险因素中是一致的（P值范围：0.09-0.99）。4项偏倚风险较低的研究中的敏感性分析与主要分析没有差异。CT/MRI LI-RADS主要特征与HCC风险因素之间的关联在HCC风险个体中没有显著差异。这些发现表明，CT/MR LI-RADS应应用于所有被LI-RADS视为有风险的患者，无需修改或排除，无论是否存在本研究中评估的风险因素。
