LI-RADS treatment response algorithm for detecting incomplete necrosis in hepatocellular carcinoma after locoregional treatment: A systematic review and meta-analysis using individual patient data Review

  

Authors:	Kim, T. H.; Woo, S.; Joo, I.; Bashir, M. R.; Park, M. S.; Burke, L. M. B.; Mendiratta-Lala, M.; Do, R. K. G.
Review Title:	LI-RADS treatment response algorithm for detecting incomplete necrosis in hepatocellular carcinoma after locoregional treatment: A systematic review and meta-analysis using individual patient data
Abstract:	Purpose: To perform a systematic review and meta-analysis using individual patient data to investigate the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) Treatment Response (TR) algorithm for detecting incomplete necrosis on pathology. Methods: PubMed and EMBASE were searched from Jan 1, 2017 until October 14, 2020. Studies reporting diagnostic accuracy of LI-RADS TR algorithm on CT or MRI for detecting incomplete necrosis on pathology as a reference standard were included. Sensitivity and specificity were pooled using random-effects model. Subgroup analyses were performed for locoregional treatment (LRT) type and imaging modality. Results: Six studies (393 patients, 534 lesions) were included. Pooled sensitivity was 0.56 (95% confidence interval [CI] 0.43–0.69) and specificity was 0.91 (95%CI 0.84–0.96). Pooled sensitivity was highest using arterial phase hyperenhancement (APHE) (0.67 [95%CI 0.51–0.81]), followed by washout (0.43 [95%CI 0.26–0.62]) and enhancement similar to pretreatment (0.24 [95%CI 0.15–0.36]). Among lesions with incomplete necrosis, 2% (95%CI 0.00–0.05) manifested as washout but no APHE; 0% (95% CI 0.00–0.02) as enhancement similar to pretreatment without both APHE and washout. Pooled sensitivity was lower after ablation than embolization (0.42 [95%CI, 0.28–0.57] vs. 0.65 [95%CI, 0.53–0.77], p = 0.033). MRI and CT were comparable (p = 0.783 and 0.290 for sensitivity and specificity). Conclusions: LI-RADS TR algorithm shows moderate sensitivity and high specificity for detecting incomplete necrosis after LRT. APHE is the dominant criterion, a washout contributes to small but meaningful extent, while the contribution of enhancement similar to pretreatment may be negligible. LRT type may affect performance of the algorithm. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Keywords:	treatment response; hepatocellular carcinoma; systematic review; meta-analysis; individual patient data; liver imaging reporting and data system (li-rads)
Journal Title:	Abdominal Radiology
Volume:	46
Issue:	8
ISSN:	2366-004X
Publisher:	Springer
Date Published:	2021-08-01
Start Page:	3717
End Page:	3728
Language:	English
DOI:	10.1007/s00261-021-03122-8
PUBMED:	34027566
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85106445903&doi=10.1007%2fs00261-021-03122-8&partnerID=40&md5=e496feb6139b49098a518cb19aa6d9e8
Notes:	Article -- Export Date: 2 August 2021 -- Source: Scopus

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