LI-RADS ancillary feature prediction of longitudinal category changes in LR-3 observations: an exploratory study



To determine whether LI-RADS ancillary features predict longitudinal LR-3 observation category changes.

Materials and Methods

This exploratory, retrospective, single-center study with an independent reading center included patients who underwent two or more multiphase CT or MRI examinations for hepatocellular carcinoma assessment between 2011 and 2015. Three readers independently evaluated each observation using CT/MRI LI-RADS v2017, and observations categorized LR-3 using major features only were included in the analysis. Prevalence of major and ancillary features was calculated. After excluding low-frequency (< 5%) features, inter-reader agreement was assessed using intraclass correlation coefficient (ICC). Major and ancillary feature prediction of observation upgrade (to LR-4 or higher) or downgrade (to LR-1 or LR-2) on follow-up imaging was assessed using logistic regression.


141 LR-3 observations in 79 patients were included. Arterial phase hyperenhancement, washout, restricted diffusion, mild-moderate T2 hyperintensity, and hepatobiliary phase hypointensity were frequent enough for further analysis (consensus prevalence 5.0–66.0%). ICCs for inter-reader agreement ranged from 0.18 for restricted diffusion to 0.48 for hepatobiliary phase hypointensity. On follow-up, 40% (57/141) of baseline LR-3 observations remained LR-3. 8% (11/141) were downgraded to LR-2, and 42% (59/141) were downgraded to LR-1. A small number were ultimately upgraded to LR-4 (2%, 3/141) or LR-5 (8%, 11/141). None of the assessed major or ancillary features was significantly associated with observation category change. Longer follow-up time was significantly associated with both observation upgrade and downgrade.


While numerous ancillary features are described in LI-RADS, most are rarely present and are not useful predictors of LR-3 observation category changes.

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Author information




ES: Primary author, data collection, analysis, and data manager. AM: Data collection, analysis, and manuscript revision. TW: Study design, statistical analysis, secondary author of statistical portion, and manuscript revision. BCA, TAJ: Data collection, study reader, and manuscript revision. SI, AH, MT: Study design, data collection, and manuscript revision. AG: Study design, statistical analysis, and manuscript revision. CBS: Study design, data collection, data analysis, and manuscript revision. MRB: Study design, study reader, data analysis, manuscript revision, and corresponding author.

Corresponding author

Correspondence to Erin Shropshire.

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Erin Shropshire, Adrija Mamidipalli, Tanya Wolfson, Brian C. Allen, Tracy A. Jaffe, Saya Igarashi, Atsushi Higaki, Masahiro Tanabe, Anthony Gamst: No grants or assistance relevant to the study, no financial disclosures. Claude B. Sirlin: Research grants: Bayer, GE, Gilead, Philips, Siemens; Personal consulting: Boehringer, Epigenomics; Representative for institutional consultation: BMS, Exact Sciences, IBM-Watson; Active lab service agreements: Enanta, Gilead, ICON, Intercept, Nusirt, Shire, Synageva, Takeda; Completed lab service agreements: Alexion, AstraZeneca, Bristol-Myers Squibb, Celgene, Galmed, Genzyme, Isis, Janssen, Pfizer, Roche, Sanofi, Virtualscopics. Mustafa R. Bashir: Research Grants: Siemens Healthcare, NGM Biopharmaceuticals, Madrigal Pharmaceuticals, Metacrine Inc., ProSciento Inc., Pinnacle Clinical Research, CymaBay Therapeutics; Consulting: MedPace.

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Shropshire, E., Mamidipalli, A., Wolfson, T. et al. LI-RADS ancillary feature prediction of longitudinal category changes in LR-3 observations: an exploratory study. Abdom Radiol 45, 3092–3102 (2020).

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  • Hepatocellular carcinoma
  • MRI