Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To compare the diagnostic performance of corresponding probability-based categories between LI-RADS v2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) v2022. MATERIALS AND METHODS: This retrospective multicenter study included treatment-naïve patients at risk of hepatocellular carcinoma (HCC) who underwent gadoxetic acid-enhanced MRI between January 2015 and June 2018. Four radiologists independently evaluated MRI and CT when available; observations were categorized according to both criteria. Reference standards were pathology or clinical diagnosis. Generalized estimating equations were used for lesion clustering. RESULTS: The study included 2237 patients (1666 men; mean age, 59 ± 11 years) with 2445 lesions. On MRI, LR-5 showed a higher positive predictive value (PPV) than KLCA-NCC "definite HCC" (93.9% vs. 91.7%, p < 0.001). PPV was not different between LR-4 and KLCA-NCC "probable HCC" (68.2% vs. 64.1%, p = 0.141). HCC proportion was 13.2% in LR-3 and 40.8% in KLCA-NCC "indeterminate nodule" (p < 0.001). In 1455 patients with 1590 lesions on CT, LR-5 and KLCA-NCC had comparable PPV (92.9% in each). PPV of KLCA-NCC "probable HCC" was higher than LR-4 (83.8% vs. 73.9%, p = 0.012). HCC proportion was 52.0% in LR-3 and 46.2% in KLCA-NCC "indeterminate nodule" (p = 0.001). CONCLUSION: Both LI-RADS v2018 and KLCA-NCC v2022 demonstrated effective probability-based risk stratification, but corresponding probability categories were not interchangeable. On CT, category performance differed from MRI, highlighting the need for modality-specific refinement to improve diagnostic precision. KEY POINTS: Question Do conceptually corresponding diagnostic categories in LI-RADS v2018 and KLCA-NCC v2022 demonstrate equivalent diagnostic performance for HCC? Findings Both systems demonstrated effective probability-based stratification, but corresponding categories were not equivalent, and the performance was modality-specific. Clinical relevance Corresponding categories are not interchangeable between the two systems. The heterogeneity within "probable HCC" and modality-specific performance differences suggest potential benefits from subcategorization and refinement of CT-specific criteria.
Source: European Radiology
Institutions: Seoul National University, Seoul National University Hospital, Chung-Ang University Hospital, Samsung Medical Center, Sungkyunkwan University, Korea University Guro Hospital, Seoul National University Bundang Hospital, Yonsei University, Severance Hospital, The Catholic University of Korea Seoul St. Mary's Hospital, Yonsei University Health System, Catholic University of Korea, Korea University Anam Hospital, CHA University Bundang Medical Center, Gangnam Severance Hospital, Kyung Hee University, Kyung Hee University Medical Center, Konkuk University, Konkuk University Medical Center
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,890
Funders: Seoul National University Bundang Hospital, Korea University Guro Hospital, Chung-Ang University, Seoul National University, Kyung Hee University, Korea University, Seoul National University Hospital, Korea University Anam Hospital, Samsung, College of Medicine, Seoul National University, Bayer Korea, Seoul St. Mary's Hospital, Catholic University of Korea
Award: G2814757118
OpenAlex ID: W7166096178