ArticleEuropean radiology2026
A multicenter multinational retrospective study of the 1-year natural history of LI-RADS 3 observations in patients with cirrhosis.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo assess the 1-year natural history of liver imaging reporting and data system (LI-RADS) 3 observations on contrast-enhanced MRI in cirrhotic patients across multiple international centers, and to identify clinical and imaging predictors of progression using multivariable and machine learning models. MATERIALS AND
methodsThis retrospective study included 347 cirrhotic patients with 540 LI-RADS 3 observations from six centers across three countries, each with 12 (±3) months of follow-up MRI. Observations were reassessed using LI-RADS v2018 criteria. Generalized linear mixed-effects models and machine learning (LASSO, random forest) evaluated predictors of progression. Area under the curve (AUC) analysis assessed the predictive performance of clinical and imaging variables.
resultsWithin one year, 28% of LI-RADS 3 observations progressed: 14% to LI-RADS 4 and 14% to LI-RADS 5. Independent predictors of progression included lesion size, with an odds ratio (OR: 1.12, 95% CI: 1.01-1.24), Child-Pugh Class C (OR: 8.36, 95% CI: 1.01-69.27), and alcohol-related liver disease (OR: 0.24, 95% CI: 0.06-0.94). Enhancing capsule and untreated hepatitis C virus were significant in univariable analysis. Imaging features improved predictive accuracy, increasing AUC from 0.65 to 0.72 (p = 0.01). A lesion size cut-off of 9.5 mm was associated with increased progression risk.
conclusionOne in four LI-RADS 3 observations progress within one year. Lesion size, liver function, and etiology are key predictors. Integration of imaging features enhances risk stratification and supports more personalized follow-up strategies for indeterminate liver lesions. KEY POINTS: Question Identifying which LI-RADS 3 liver observations progress to malignancy remains challenging; evidence from large, standardized, multicenter MRI cohorts is lacking. Findings In this large multinational study, 28% of LI-RADS 3 observations progressed within one year; lesion size, liver dysfunction, and disease etiology were key independent predictors. Clinical relevance LI-RADS 3 observations show significant progression risk, with imaging features improving prediction models and guiding surveillance strategies for early HCC detection.
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