BACKGROUND & AIMS Non-invasive imaging is crucial for the early diagnosis and successful treatment of hepatocellular carcinoma (HCC). Terminology and criteria for interpreting and reporting imaging results must be standardized to optimize diagnosis. The aim of this study was to prospectively compare the diagnostic accuracy of the American Association for the Study of Liver Diseases (AASLD) and the 2014 version of Liver Imaging Reporting and Data System (LI-RADS®) criteria for the non-invasive diagnosis of small HCC, and to evaluate the diagnostic value of ancillary features used in the LI-RADS criteria. METHODS Between April 2009 and April 2012, patients with cirrhosis and one to three 10-30 mm nodules were enrolled and underwent computed tomography (CT) and magnetic resonance (MR) imaging. The diagnostic accuracy of both the AASLD and the LI-RADS criteria were determined based on their sensitivity, specificity, positive (PPV) and negative predictive values (NPV). RESULTS A total of 595 nodules were included (559 [341 HCC, 61%] with MR imaging and 529 [332 HCC, 63%] with CT). Overall, no (0%) LR-1 and LR-2, 44 (33%) and 47 (41%) LR-3, 50 (53%) and 54 (55%) LR-4, 244 (94%) and 222 (91%) LR-5 and 4 (67%) and 9 (82%) LR-5V were HCC on MR imaging and CT, respectively. The sensitivity, specificity, PPV/NPV of the AASLD score was 72.5%, 87.6%, 90.2%, and 66.9% for MR imaging, and 71.4%, 77.7%, 84.3%, 61.7% for CT, respectively. For the combination of LR-5V and LR-5 nodules these measures were 72.5%, 89.9%, 91.9% and 67.5% on MRI and 66.9%, 88.3%, 90.9% and 63.3% on CT, respectively. For the combination of LR-5V, LR-5 and LR-4 nodules they were 87.1%, 69.1%, 81.6% and 77.3% on MRI and 85.8%, 66%, 81% on 73.5% on CT, respectively. CONCLUSION The 2014 version of the LI-RADS is no more accurate than the AASLD score for the non-invasive diagnosis of small HCC in high-risk patients, but it provides important and complementary information on the probability of having HCC in high-risk patients, allowing for possible changes in the management of these patients. LAY SUMMARY The 2014 version of Liver Imaging Reporting and Data System criteria does not outperform the American Association for the Study of Liver Diseases criteria for the non-invasive diagnosis of hepatocellular carcinoma (HCC) smaller than 3 cm. Liver Imaging Reporting and Data System offers a nodule-based evaluation of the risk of HCC, allowing possible changes in management in these patients. The added value of ancillary features appears limited for the non-invasive diagnosis of small HCC.

中文翻译：

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AASLD与LI-RADS标准对小于3 cm HCC无创诊断准确性的比较

背景和目的 非侵入性成像对于肝细胞癌 (HCC) 的早期诊断和成功治疗至关重要。解释和报告成像结果的术语和标准必须标准化以优化诊断。本研究的目的是前瞻性比较美国肝病研究协会 (AASLD) 和 2014 版肝脏影像报告和数据系统 (LI-RADS®) 标准对肝病无创诊断的诊断准确性。小 HCC，并评估 LI-RADS 标准中使用的辅助特征的诊断价值。方法 2009 年 4 月至 2012 年 4 月，纳入 1 至 3 个 10-30 毫米结节的肝硬化患者，并接受计算机断层扫描 (CT) 和磁共振 (MR) 成像。AASLD 和 LI-RADS 标准的诊断准确性是根据它们的敏感性、特异性、阳性 (PPV) 和阴性预测值 (NPV) 确定的。结果 共纳入 595 个结节（MR 成像 559 个 [341 个 HCC，61%]，CT 显示 529 个 [332 个 HCC，63%]）。总体而言，没有 (0%) LR-1 和 LR-2、44 (33%) 和 47 (41%) LR-3、50 (53%) 和 54 (55%) LR-4、244 (94%)和 222 (91%) LR-5 和 4 (67%) 和 9 (82%) LR-5V 在 MR 成像和 CT 上分别是 HCC。AASLD评分的敏感性、特异性、PPV/NPV对于MR成像分别为72.5%、87.6%、90.2%和66.9%，对于CT分别为71.4%、77.7%、84.3%、61.7%。对于 LR-5V 和 LR-5 结节的组合，这些测量值在 MRI 上分别为 72.5%、89.9%、91.9% 和 67.5%，在 CT 上分别为 66.9%、88.3%、90.9% 和 63.3%。对于LR-5V的组合，LR-5 和 LR-4 结节在 MRI 上分别为 87.1%、69.1%、81.6% 和 77.3%，在 CT 上分别为 85.8%、66%、81% 和 73.5%。结论 2014 版 LI-RADS 对高危患者小肝癌的无创诊断并不比 AASLD 评分准确，但它为高危患者患 HCC 的概率提供了重要的补充信息，允许对这些患者的管理进行可能的改变。常规总结 2014 版肝脏影像报告和数据系统标准并未超过美国肝病研究协会对小于 3 cm 的肝细胞癌 (HCC) 进行非侵入性诊断的标准。肝脏影像报告和数据系统提供基于结节的 HCC 风险评估，允许对这些患者的管理进行可能的改变。