EASL versus LI‐RADS: Intra‐individual comparison of MRI with extracellular contrast and gadoxetic acid for diagnosis of small HCC

Background & Aims Liver Imaging Reporting and Data System (LI‐RADS) and European Association for the Study (EASL) criteria for hepatocellular carcinoma (HCC) diagnosis have been updated in 2018. We aimed to compare the HCC diagnostic performance of LI‐RADS and EASL criteria with extracellular contrast agents‐MRI (ECA‐MRI) and hepatobiliary agents‐MRI (HBA‐MRI). Methods We prospectively evaluated 179 participants with cirrhosis (n = 105) or non‐cirrhotic chronic hepatitis B (CHB) (n = 74) who underwent both ECA‐MRI and HBA‐MRI before surgery for de novo nodule(s) measuring 10‐30 mm. We compared the HCC diagnostic performance of EASL and LR‐5 in both MRIs. Results In an analysis of 215 observations (175 HCCs, 17 non‐HCC malignancies and 23 benign lesions) identified from cirrhotic or non‐cirrhotic CHB participants, LR‐5 with ECA‐MRI provided the highest sensitivity (80.7%), followed by EASL with ECA‐MRI (76.2%), LR‐5 with HBA‐MRI (67.3%) and EASL with HBA‐MRI (63.0%, all P