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Four radiologists independently evaluated MRI and CT when available; observations were categorized according to both criteria. Reference standards were pathology or clinical diagnosis. Generalized estimating equations were used for lesion clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 2237 patients (1666 men; mean age, 59\u2009\u00b1\u200911 years) with 2445 lesions. On MRI, LR-5 showed a higher positive predictive value (PPV) than KLCA-NCC \u201cdefinite HCC\u201d (93.9% vs. 91.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). PPV was not different between LR-4 and KLCA-NCC \u201cprobable HCC\u201d (68.2% vs. 64.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.141). HCC proportion was 13.2% in LR-3 and 40.8% in KLCA-NCC \u201cindeterminate nodule\u201d (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In 1455 patients with 1590 lesions on CT, LR-5 and KLCA-NCC had comparable PPV (92.9% in each). PPV of KLCA-NCC \u201cprobable HCC\u201d was higher than LR-4 (83.8% vs. 73.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). HCC proportion was 52.0% in LR-3 and 46.2% in KLCA-NCC \u201cindeterminate nodule\u201d (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both LI-RADS v2018 and KLCA-NCC v2022 demonstrated effective probability-based risk stratification, but corresponding probability categories were not interchangeable. On CT, category performance differed from MRI, highlighting the need for modality-specific refinement to improve diagnostic precision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Do conceptually corresponding diagnostic categories in LI-RADS v2018 and KLCA-NCC v2022 demonstrate equivalent diagnostic performance for HCC?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Both systems demonstrated effective probability-based stratification, but corresponding categories were not equivalent, and the performance was modality-specific<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Corresponding categories are not interchangeable between the two systems. The heterogeneity within \u201cprobable HCC\u201d and modality-specific performance differences suggest potential benefits from subcategorization and refinement of CT-specific criteria.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12696-0","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:03:32Z","timestamp":1782482612000},"page":"8451-8464","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["LI-RADS v2018 versus KLCA-NCC v2022: comparison of probability-based HCC categories"],"prefix":"10.1007","volume":"36","author":[{"given":"Jeong Hee","family":"Yoon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Sun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Kon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Hee","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Woo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Il","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beom Jin","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Young","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-seob","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Sik","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Jin","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung-Won","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myoung-jin","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Sun","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0561-8777","authenticated-orcid":false,"given":"Jeong Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"12696_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Otherwise, the authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"One of the authors (Myoung-jin Jang, PhD) has significant statistical expertise.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was waived by the Institutional Review Board at each participating institution due to the study's retrospective design.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained in all participating institutions.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The study cohort data were published elsewhere for different study purposes. It is further described in the manuscript.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}