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Liver Imaging Reporting and Data System Version 2018: Impact on Categorization and Hepatocellular Carcinoma Staging

The purpose of this study was to assess the concordance in categorization and radiologic T staging using Liver Imaging Reporting and Data System (LI‐RADS, LR) version 2017 (v2017), version 2018 (v2018), and the Organ Procurement and Transplantation Network (OPTN) criteria. All magnetic resonance imaging and computed tomography reports using a standardized LI‐RADS macro between April 2015 and March 2018 were identified retrospectively. The major features (size, arterial phase hyperenhancement, washout, enhancing capsule, or threshold growth) were extracted from the report for each LR‐3, LR‐4, and LR‐5 observation. Each observation was assigned a new category based on LI‐RADS v2017, v2018, and OPTN criteria. Radiologic T stage was calculated based on the size and number of LR‐5 or OPTN class 5 observations. Categories and T stages assigned by each system were compared descriptively. There were 398 patients (66.6% male; mean age, 63.4 years) with 641 observations (median size, 14 mm) who were included. A total of 73/182 (40.1%) observations categorized LR‐4 by LI‐RADS v2017 were up‐categorized to LR‐5 by LI‐RADS v2018 due to changes in the LR‐5 criteria, and 4/196 (2.0%) observations categorized as LR‐5 by LI‐RADS v2017 were down‐categorized to LR‐4 by LI‐RADS v2018 due to changes in the threshold growth definition. The T stage was higher by LI‐RADS v2018 than LI‐RADS v2017 in 49/398 (12.3%) patients. Compared with the OPTN stage, 12/398 (3.0%) patients were upstaged by LI‐RADS v2017 and 60/398 (15.1%) by LI‐RADS v2018. Of 101 patients, 5 (5.0%) patients with T2 stage based on LI‐RADS v2017 and 10/102 (9.8%) patients with T2 stage based on LI‐RADS v2018 did not meet the T2 criteria based on the OPTN criteria. Of the 98 patients with a T2 stage based on OPTN criteria, 2 (2.0%) had a T stage ≥3 based on LI‐RADS v2017 and 6 (6.1%) had a T stage ≥3 based on LI‐RADS v2018.