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

PurposeTo evaluate the diagnostic performance of LI-RADS among patients with non-cirrhotic hepatitis C virus (HCV) infection.MethodsThis 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.ResultsOf 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.ConclusionCT/MRI LI-RADS v2018 criteria can be applied to non-cirrhotic HCV patients with near-perfect specificity.