ArticleEuropean radiology2026
LI-RADS v2018 versus KLCA-NCC v2022: comparison of probability-based HCC categories.
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 compare the diagnostic performance of corresponding probability-based categories between LI-RADS v2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) v2022. MATERIALS AND
methodsThis retrospective multicenter study included treatment-naïve patients at risk of hepatocellular carcinoma (HCC) who underwent gadoxetic acid-enhanced MRI between January 2015 and June 2018. Four radiologists independently evaluated MRI and CT when available; observations were categorized according to both criteria. Reference standards were pathology or clinical diagnosis. Generalized estimating equations were used for lesion clustering.
resultsThe study included 2237 patients (1666 men; mean age, 59 ± 11 years) with 2445 lesions. On MRI, LR-5 showed a higher positive predictive value (PPV) than KLCA-NCC "definite HCC" (93.9% vs. 91.7%, p < 0.001). PPV was not different between LR-4 and KLCA-NCC "probable HCC" (68.2% vs. 64.1%, p = 0.141). HCC proportion was 13.2% in LR-3 and 40.8% in KLCA-NCC "indeterminate nodule" (p < 0.001). In 1455 patients with 1590 lesions on CT, LR-5 and KLCA-NCC had comparable PPV (92.9% in each). PPV of KLCA-NCC "probable HCC" was higher than LR-4 (83.8% vs. 73.9%, p = 0.012). HCC proportion was 52.0% in LR-3 and 46.2% in KLCA-NCC "indeterminate nodule" (p = 0.001).
conclusionBoth LI-RADS v2018 and KLCA-NCC v2022 demonstrated effective probability-based risk stratification, but corresponding probability categories were not interchangeable. On CT, category performance differed from MRI, highlighting the need for modality-specific refinement to improve diagnostic precision. KEY POINTS: Question Do conceptually corresponding diagnostic categories in LI-RADS v2018 and KLCA-NCC v2022 demonstrate equivalent diagnostic performance for HCC? Findings Both systems demonstrated effective probability-based stratification, but corresponding categories were not equivalent, and the performance was modality-specific. Clinical relevance Corresponding categories are not interchangeable between the two systems. The heterogeneity within "probable HCC" and modality-specific performance differences suggest potential benefits from subcategorization and refinement of CT-specific criteria.
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