Purpose: We compared the diagnostic performances of the European Association for the Study of the Liver (EASL) 2018 and Liver Imaging Reporting and Data System (LI-RADS) 2018 criteria on magnetic resonance imaging (MRI) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients and evaluated the difference in diagnostic value between MRI with extracellular contrast agents (ECA-MRI) and MRI with hepatobiliary agents (HBA-MRI). Methods: This study included 382 observations from 298 patients at high risk for HCC who underwent preoperative multiphasic contrast-enhanced MRI between January 2015 and December 2016. Two readers assessed all observations according to the EASL 2018 and LI-RADS 2018 criteria, and the per-observation diagnostic performances were compared. Results: On ECA-MRI, the LR-5 category of LI-RADS 2018 showed significantly higher sensitivity (78.9% vs. 71.5%, p = 0.005) and accuracy (81.7% vs. 75.0%, p = 0.003) for the diagnosis of HCC than the EASL 2018. On HBA-MRI, the diagnostic performances of the EASL 2018 and LR-5 of LI-RADS 2018 were not significantly different. When using EASL 2018, no statistically significant differences were observed in the diagnostic performances between ECA-MRI and HBA-MRI; however, when using the LR-5 of LI-RADS 2018, ECA-MRI had a higher sensitivity (78.9% vs. 67.5%, p = 0.029) than HBA-MRI. Conclusions: On ECA-MRI, the LR-5 category of LI-RADS 2018 provides better sensitivity and accuracy than the EASL 2018 for diagnosing HCC. EASL 2018 provides comparable diagnostic performances between ECA-MRI and HBA-MRI, but the LR-5 category of LI-RADS 2018 provides better sensitivity on ECA-MRI than on HBA-MRI.
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