Diagnostic performance of CT/MRI LI-RADS v2018 in non-cirrhotic hepatitis C virus infection

To evaluate the diagnostic performance of LI-RADS among patients with non-cirrhotic hepatitis C virus (HCV) infection.

This retrospective, IRB-approved, single-center study included 66 observations from 43 adult patients (11 women, 32 men; median age 65 years). All patients received liver protocol CT or MRI from 2010 to 2023, had HCV, and did not have cirrhosis based on histopathology. Three board-certified abdominal radiologists blinded to histopathology and imaging follow-up assessed each observation for major features and final LI-RADS category, and inter-reader agreements with weighted kappa were calculated. The positive predictive value, sensitivity, specificity, and accuracy of in diagnosing HCC and overall malignancy was calculated.

Of the 66 observations, 53 (80%) were malignant and 13 (20%) were benign. Positive predictive value for HCC was 0–0% for LR-1, 0–0% for LR-2, 0–33% for LR-3, 57–100% for LR-4, 98–100% for LR-5, 25–50% for LR-M, and 83–100% for LR-TIV. Positive predictive value for overall malignancy was 0–0% for LR-1, 0–0% for LR-2, 0–33% for LR-3, 57–100% for LR-4, 98–100% for LR-5, 100–100% for LR-M, and 100–100% for LR-TIV. For LR-5 in identifying HCC, sensitivity ranged from 74 to 90%, specificity from 94 to 100%, and accuracy from 80 to 91%. For the composite of LR-5, LR-M, or LR-TIV in identifying overall malignancy, sensitivity was 87–98%, specificity was 92–100%, and accuracy was 89–97%. The inter-reader agreement for major features varied from moderate to substantial, with substantial agreement for the final category.

CT/MRI LI-RADS v2018 criteria can be applied to non-cirrhotic HCV patients with near-perfect specificity.