Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients

Abstract

The Liver Imaging Reporting and Data System (LI-RADS) is composed of four individual algorithms intended to standardize the lexicon, as well as reporting and care, in patients with or at risk for hepatocellular carcinoma in the context of surveillance with US; diagnosis with CT, MRI, or contrast material-enhanced US; and assessment of treatment response with CT or MRI. This report provides a broad overview of LI-RADS, including its historic development, relationship to other imaging guidelines, composition, aims, and future directions. In addition, readers will understand the motivation for and key components of the 2018 update.

Liver Imaging Reporting and Data System Version 2018: Impact on Categorization and Hepatocellular Carcinoma Staging

“…Integration of LI‐RADS into the AASLD HCC Practice Guidance was a major achievement in 2018, bringing the field closer to the overall goal of unifying HCC imaging diagnostic criteria . To accomplish the integration, a change in the LR‐5 criteria and a simplification of the threshold growth definition were required .…”

“…Observations were also excluded if the report indicated the presence of concomitant LR‐TIV or LR‐M observations. One patient with cardiac cirrhosis diagnosed on liver explant pathology was excluded per LI‐RADS population exclusion criteria . For patients with multiple qualifying examinations in the study period, the earliest examination was selected for analysis, and each observation was analyzed only once.…”

“…On the basis of the extracted MFs and antecedent US visibility, each observation was then assigned 3 categories: 1 category based on LI‐RADS v2017, 1 based on LI‐RADS v2018, and 1 based on the OPTN system (Table ) . Observations categorized LR‐3, LR‐4, or LR‐5 by LI‐RADS v2017 were included in subsequent analyses.…”

“…After its initial release in 2011, the LI‐RADS CT/MRI diagnostic algorithm was updated in 2013, 2014, 2017, and 2018. The latest update included 2 substantive changes that allowed integration of the LI‐RADS algorithm into the American Association for the Study of Liver Diseases (AASLD) HCC Practice Guidance . As summarized in Fig.…”

“…As summarized in Fig. , 1 change was to remove the requirement for ultrasound (US) visibility for 10‐19 mm observations with nonrim APHE and nonperipheral WO . As a result, all 10‐19 mm observations with nonrim APHE and nonperipheral WO are categorized LR‐5 by version 2018 (v2018), regardless of US visibility.…”