Liver Imaging Reporting and Data System Categorization of Benign and Malignant Tumors on Contrast-Enhanced Computed Tomography
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Background: The Liver Imaging Reporting and Data System (LI-RADS) standardizes CT and MRI interpretation of hepatic observations in patients at risk for hepatocellular carcinoma (HCC). LI-RADS categories communicate progressively increasing probability of HCC but are intended for defined at-risk populations rather than unrestricted assessment of liver lesions. Objective: To evaluate the distribution of LI-RADS categories and their association with a study-defined final benign or malignant diagnosis on contrast-enhanced CT. Methods: A prospective cross-sectional study included 132 adults undergoing contrast-enhanced CT assessment of liver disease at THQ-level facilities in Punjab. CT observations were categorized from LR-1 through LR-5. Arterial enhancement, washout, biliary dilation, portal-vein findings, ascites, and lesion characteristics were recorded. Results: LI-RADS distribution was LR-1 in 15/132 cases (11.4%), LR-2 in 27 (20.5%), LR-3 in 34 (25.8%), LR-4 in 23 (17.4%), and LR-5 in 33 (25.0%). Final study classification was benign in 43 cases and malignant in 89. All LR-1 and LR-2 observations were classified as benign; LR-3 included one benign and 33 malignant observations, whereas all LR-4 and LR-5 observations were classified as malignant. The association between LI-RADS category and diagnosis was very strong, χ²(4)=127.58, p<0.001, Cramér's V=0.983. Using the study-defined threshold of LR≥3 as positive yielded sensitivity of 100%, specificity of 97.7%, positive predictive value of 98.9%, negative predictive value of 100%, and accuracy of 99.2%. Conclusion: LI-RADS category was strongly associated with the study-defined benign/malignant classification. However, these very high diagnostic estimates should be interpreted cautiously because the independence of the diagnostic reference standard, LI-RADS eligibility of all participants, and conflicting focal-lesion counts remain important methodological limitations.
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