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June 4, 2026
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Abstract

Background. The Liver Imaging Reporting and Data System (LI-RADS) standardizes interpretation and reporting of liver computed tomography (CT) and magnetic resonance imaging (MRI) in patients at risk for hepatocellular carcinoma (HCC). Its per-category diagnostic performance against a histopathological reference standard has been characterized largely in high-resource settings.


Objective. To determine the diagnostic accuracy of LI-RADS version 2018 (v2018) for HCC against histopathology in at-risk patients, to quantify per-category positive predictive value (PPV), and to compare the LR-5, combined LR-4/5, and ordinal LI-RADS strategies.


Patients and methods. A retrospective single-center diagnostic-accuracy cohort study was conducted at Al-Hussein Teaching Hospital. At-risk patients with a multiphasic liver CT or MRI and a histopathological reference standard (resection, explant, or core-needle biopsy) for the index observation were included. The primary outcomes were per-category PPV for HCC, and the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of LR-5, combined LR-4/5, and ordinal LI-RADS.


Results. Of 388 patients screened, 247 observations in 218 patients formed the analytic cohort; 158 (64.0%) were HCC. PPV for HCC rose monotonically across categories: 0% (LR-1), 4.5% (LR-2), 9.1% (LR-3), 44.4% (LR-4), and 92.6% (LR-5). LR-5 achieved a sensitivity of 82.3% (95% confidence interval [CI] 75.4–87.9%) and specificity of 94.4% (95% CI 87.4–98.2%), with an AUC of 0.88 (95% CI 0.83–0.93).


Conclusions. LI-RADS v2018 LR-5 demonstrated high specificity and good sensitivity for HCC against histopathology in this Iraqi cohort.

Keywords

LI-RADS Hepatocellular carcinoma Structured reporting Computed tomography

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Copyright (c) 2026 Firas Abdullah AlBaghdadi

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