European Radiology

, Volume 29, Issue 1, pp 186–194 | Cite as

LI-RADS v2017 categorisation of HCC using CT: Does moderate to severe fatty liver affect accuracy?

  • Seung Soo KimEmail author
  • Jeong Ah Hwang
  • Hyeong Cheol Shin
  • Seo-Youn Choi
  • Tae Wook Kang
  • Sung Shick Jou
  • Woong Hee Lee
  • Suyeon Park
  • Nam Hun Heo
Computed Tomography



To compare the sensitivity of Liver Imaging Reporting and Data System (LI-RADS) v2017 for diagnosis of hepatocellular carcinoma (HCC) using multiphasic computed tomography (CT) between patients with and without moderate to severe fatty liver (MSFL).


This retrospective study included a total of 106 high-risk patients with 112 pathologically proven HCCs who underwent multiphasic CT. Patients were classified as MSFL (24 men, 2 women; mean age, 59.5 years [range, 38–79 years]) and non-MSFL (64 men, 16 women; mean age, 62.9 years [range, 40–89 years]) groups according to unenhanced CT liver and spleen parenchymal attenuation. Two independent radiologists assigned LI-RADS categories and accessed HCC features on CT. Sensitivities for LR-5 assignment and frequencies of HCC features were compared between the two groups.


Sensitivities of LR-5 assignment for diagnosing HCCs were not significantly different between MSFL and non-MSFL groups (65.4% [17/26] vs. 76.7% [66/86] for reviewer 1, p = 0.247; 73.1% [19/26] vs. 76.74% [66/86] for reviewer 2, p = 0.702). No significant differences in the frequencies of arterial hyperenhancement, washout, and capsule were observed between the two groups (96.2% [25/26] vs. 98.8% [85/86], p = 0.412; 80.8% [21/26] vs. 89.5% [77/86], p = 0.308; and 53.8% [14/26] vs. 57% [49/86], p = 0.778, respectively).


LI-RADS v2017 using CT showed comparable sensitivity for diagnosing HCC regardless of MSFL.

Key Points

• Using LI-RADS v2017 with CT, diagnosis of HCC in patients with MSFL showed similar sensitivity to that in patients without MSFL.

• Frequencies of major HCC features (arterial hyperenhancement, washout, and capsule) on CT between the MSFL and non-MSFL groups were not significantly different.

• LI-RADS using CT may be feasible for diagnosing HCC in patients with fatty liver.


Carcinoma, hepatocellular Fatty liver Multidetector computed tomography Liver neoplasms 



Computed tomography


Hepatocellular carcinoma


Hounsfield units


Intraclass correlation coefficient


Liver cirrhosis


Liver Imaging Reporting and Data System


Moderate to severe fatty liver


Non-alcoholic fatty liver disease


Region of interest


Tumour in vein



This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

This work was supported by the Soonchunhyang University Research Fund.

Compliance with ethical standards


The specific guarantor of this publication is Sung Shick Jou, the head of the Radiology Department of Soonchunhyang University College of Medicine, Cheonan Hospital, Republic of Korea

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Suyeon Park and Nam Hun Heo kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board because of the retrospective nature of the study.

Ethical approval

Institutional Review Board approval was obtained.


Retrospective, observational, performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Seung Soo Kim
    • 1
    Email author
  • Jeong Ah Hwang
    • 1
  • Hyeong Cheol Shin
    • 1
  • Seo-Youn Choi
    • 2
  • Tae Wook Kang
    • 3
  • Sung Shick Jou
    • 1
  • Woong Hee Lee
    • 1
  • Suyeon Park
    • 4
  • Nam Hun Heo
    • 5
  1. 1.Department of RadiologySoonchunhyang University College of Medicine, Cheonan HospitalCheonan-siRepublic of Korea
  2. 2.Department of RadiologySoonchunhyang University College of Medicine, Bucheon HospitalBucheonRepublic of Korea
  3. 3.Department of Radiology and Center for Imaging ScienceSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Department of Biomedical StatisticsSoonchunhyang University Seoul HospitalSeoulRepublic of Korea
  5. 5.Clinical Trial Center, Soonchunhyang University Cheonan HospitalCheonan-siRepublic of Korea

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