Diagnostic Performance of LI-RADS v2018 versus KLCA-NCC 2018 Criteria for Hepatocellular Carcinoma Using Magnetic Resonance Imaging with Hepatobiliary Agent: A Systematic Review and Meta-Analysis of Comparative Studies

Background/Aims: To compare the performance of the Liver Imaging Reporting and Data System (LI-RADS) v2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria for diagnosing hepatocellular carcinoma (HCC) using magnetic resonance imaging (MRI) with hepatobiliary agent (HBA). Methods: We searched the MEDLINE and EMBASE for studies from January 1, 2018, to October 20, 2021, that compared the diagnostic performance of two imaging criteria on HBA-MRI. A bivariate random-effects model was fitted to calculate the per-observation sensitivity and specificity, and the estimates of paired data were compared. Subgroup analysis was performed based on the observation size. Meta-regression analysis was also performed for study heterogeneity. Results: Of the six studies included, the pooled sensitivity of the definite HCC category of the KLCA-NCC criteria (82%; 95% confidence interval [CI], 74% to 90%; I²=84%) was higher than that of LR-5 of LI-RADS v2018 (65%; 95% CI, 52% to 77%; I²=96%) for diagnosing HCC (p<0.001), while the specificity was lower for KLCA-NCC criteria (87%; 95% CI, 84% to 91%; I²=0%) than LI-RADS v2018 (93%; 95% CI, 91% to 96%; I²=0%) (p=0.017). For observations sized ≥20 mm, the sensitivity was higher for KLCA-NCC 2018 than for LI-RADS v2018 (84% vs 74%, p=0.012), with no significant difference in specificity (81% vs 85%, p=0.451). The reference standard was a significant factor contributing to the heterogeneity of sensitivities. Conclusions: The definite HCC category of KLCA-NCC 2018 provided a higher sensitivity and lower specificity than the LR-5 of LI-RADS v2018 for diagnosing HCC using MRI with HBA.