CT/MR LI-RADS 2018: clinical implications and management recommendations

Kamath, Amita; Roudenko, Alexandra; Hecht, Elizabeth M.; Sirlin, Claude B.; Chernyak, Victoria; Fowler, Kathryn J.; Mitchell, Donald G.

doi:10.1007/s00261-018-1868-6

Cited by 34 publications

(19 citation statements)

References 18 publications

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“…LR-5 (i.e., definite HCC) is defined by major criteria including size, arterial enhancement, delayed washout, and the presence of a pseudocapsule. 25,26 These lesions have a 97% positive predictive value for being HCC and can be treated as such without requiring a biopsy. 27 In contrast, LR-4 lesions (suspicious but not definite for HCC) and LR-M (worrisome for malignancy, not definitely HCC) can be HCC in 74 and 36% of cases, respectively; however, they typically require either short interval imaging or biopsy to confirm the diagnosis.…”

Section: Demonstrated Benefits Of Multidisciplinary Care In Patients mentioning

confidence: 99%

Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma

et al. 2021

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Despite advances in treatment options for hepatocellular carcinoma (HCC), 5-year survival for HCC remains below 20%. This poor survival is multifactorial but is partly related to underuse of curative treatment in clinical practice. In light of growing treatment options, delivered by different types of providers, optimal management requires input from multiple specialties. A multidisciplinary approach has been evolving over the past couple of decades, bringing different specialists together to develop a therapeutic plan to treat and manage HCC, which significantly increases timely guideline-concordant treatment and improves overall survival. The present review attempts to highlight the need for such a multimodal approach by providing insights on its potential structure and impact on the various aspects of HCC management.

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Section: Demonstrated Benefits Of Multidisciplinary Care In Patients mentioning

confidence: 99%

Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma

et al. 2021

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“…Similarly, management may be influenced by institutional or regional practice patterns and resources. 33 …”

Section: The Role and Value Of Ct/mri Li-radsmentioning

confidence: 99%

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

Cunha¹,

Chernyak²,

Fowler³

et al. 2021

JHC

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Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide and a major healthcare burden in most societies. Computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the medical care of patients with or at risk for hepatocellular carcinoma (HCC). When stringent imaging criteria are fulfilled, CT and MRI allow for diagnosis, staging, and assessment of response to treatment, without the need for invasive workup, and can inform clinical decision making. Owing to the central role of these imaging modalities in HCC management, standardization is essential to facilitate proper imaging technique, accurate interpretation, and clear communication among all stakeholders in both the clinical practice and research settings. The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system that provides standardization across the continuum of HCC imaging, including ordinal probabilistic approach for reporting that directs individualized management. This review discusses the up-to-date role of CT and MRI in HCC imaging from the LI-RADS perspective. It also provides a glimpse into the future by discussing how advances in knowledge and technology are likely to enrich the LI-RADS approach.

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“…LR-3 are lesions with intermediate risk of being HCC, LR-4 include observations that are probably HCC, while LR-5 are considered definitely HCC. 49 LI-RADS algorithm can be applied to both CT and MRI examinations in patients with cirrhosis, chronic hepatitis B infection, and in patients with prior HCC. 49 , 50 The categorization of the lesions using LI-RADS is based on major imaging criteria with arterial phase hyperenhancement and washout appearance, being the most important.…”

Section: Imaging Diagnosis Of Hepatocellular Carcinomamentioning

confidence: 99%

“… 39 Some other features, such as subtreshold growth, fat sparing in solid mass, blood products in mass, and transitional phase hypointensity have also been included as ancillary features for HCC diagnosis in latest LI-RADS algorithm. 48 , 49 …”

Section: Imaging Diagnosis Of Hepatocellular Carcinomamentioning

confidence: 99%

An overview of hepatocellular carcinoma with atypical enhancement pattern: spectrum of magnetic resonance imaging findings with pathologic correlation

Kovač

Ivanović

Milovanović

et al. 2021

Radiology and Oncology

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Background In the setting of cirrhotic liver, the diagnosis of hepatocellular carcinoma (HCC) is straightforward when typical imaging findings consisting of arterial hypervascularity followed by portal-venous washout are present in nodules larger than 1 cm. However, due to the complexity of hepatocarcinogenesis, not all HCCs present with typical vascular behaviour. Atypical forms such as hypervascular HCC without washout, isovascular or even hypovascular HCC can pose diagnostic dilemmas. In such cases, it is important to consider also the appearance of the nodules on diffusion-weighted imaging and hepatobiliary phase. In this regard, diffusion restriction and hypointensity on hepatobiliary phase are suggestive of malignancy. If both findings are present in hypervascular lesion without washout, or even in iso- or hypovascular lesion in cirrhotic liver, HCC should be considered. Moreover, other ancillary imaging findings such as the presence of the capsule, fat content, signal intensity on T2-weighted image favour the diagnosis of HCC. Another form of atypical HCCs are lesions which show hyperintensity on hepatobiliary phase. Therefore, the aim of the present study was to provide an overview of HCCs with atypical enhancement pattern, and focus on their magnetic resonance imaging (MRI) features. Conclusions In order to correctly characterize atypical HCC lesions in cirrhotic liver it is important to consider not only vascular behaviour of the nodule, but also ancillary MRI features, such as diffusion restriction, hepatobiliary phase hypointensity, and T2-weighted hyperintensity. Fat content, corona enhancement, mosaic architecture are other MRI feautures which favour the diagnosis of HCC even in the absence of typical vascular profile.

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CT/MR LI-RADS 2018: clinical implications and management recommendations

Cited by 34 publications

References 18 publications

Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma

Role of Multidisciplinary Care in the Management of Hepatocellular Carcinoma

Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

An overview of hepatocellular carcinoma with atypical enhancement pattern: spectrum of magnetic resonance imaging findings with pathologic correlation

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