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Digestive Disease Interventions 2017; 01(02): 083-093
DOI: 10.1055/s-0037-1603562
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Liver Imaging Reporting and Data System Classification of Hepatocellular Carcinoma: Implications for Clinical Management

Samuel Borofsky
1   Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
,
Jay Karajgikar
1   Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
,
Sandeep P. Deshmukh
1   Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
,
Christopher G. Roth
1   Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
› Author Affiliations
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Publication History

12 February 2017

25 April 2017

Publication Date:
05 June 2017 (online)

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Abstract

As the incidence of hepatocellular carcinoma (HCC) continues to increase worldwide, the role imaging plays in management continues to gain clinical importance. Multiple entry points exist for patients in the scheme of diagnosis and treatment of HCC and non-HCC malignancies. Further complicating this scheme is the lack of standardization in the language used for diagnostic imaging and management recommendations. The Liver Imaging Reporting and Data System (LI-RADS) was created to improve communication between clinicians and management teams. LI-RADS serves to standardize reports, improving physician satisfaction and aiding in management decisions across the continuum of care of these patients. Furthermore, LI-RADS provides technical specifications across multiple imaging modalities for screening and follow-up examinations, with the end goal of curing the disease or prolonging survival. In this review, the LI-RADS algorithm will be expanded upon, as well as its utility for various treatment options using the standardized LI-RADS lexicon. Additionally, pitfalls and non-HCC malignancies will also be addressed with resultant improvement in reproducibility of radiology reports that guide therapeutic management.

Keywords

hepatocellular carcinoma - cirrhosis - liver transplantation
 

  • References

  • 1 Purysko AS, Remer EM, Coppa CP, Leão Filho HM, Thupili CR, Veniero JC. LI-RADS: a case-based review of the new categorization of liver findings in patients with end-stage liver disease. Radiographics 2012; 32 (07) 1977-1995
    CrossrefPubMedGoogle Scholar
  • 2 European Association for Study of Liver; European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer 2012; 48 (05) 599-641
    CrossrefPubMedGoogle Scholar
  • 3 El-Serag HB. Hepatocellular carcinoma. N Engl J Med 2011; 365 (12) 1118-1127
    CrossrefPubMedGoogle Scholar
  • 4 Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology 2015; 61 (03) 1056-1065
    CrossrefPubMedGoogle Scholar
  • 5 Schwartz LH, Panicek DM, Berk AR, Li Y, Hricak H. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260 (01) 174-181
    CrossrefPubMedGoogle Scholar
  • 6 Petruzzi N, Mitchell D, Guglielmo F. , et al. Hepatocellular carcinoma likelihood on MRI exams: evaluation of a standardized categorization system. Acad Radiol 2013; 20 (06) 694-698
    CrossrefPubMedGoogle Scholar
  • 7 Choi D, Kim SH, Lim JH. , et al. Detection of hepatocellular carcinoma: combined T2-weighted and dynamic gadolinium-enhanced MRI versus combined CT during arterial portography and CT hepatic arteriography. J Comput Assist Tomogr 2001; 25 (05) 777-785
    CrossrefPubMedGoogle Scholar
  • 8 Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev 2007; 33 (05) 437-447
    CrossrefPubMedGoogle Scholar
  • 9 Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362 (9399): 1907-1917
    CrossrefPubMedGoogle Scholar
  • 10 Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 2013; 266 (02) 376-382
    CrossrefPubMedGoogle Scholar
  • 11 Bruix J, Sherman M. ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (03) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 12 Kudo M, Izumi N, Kokudo N. , et al; HCC Expert Panel of Japan Society of Hepatology. Management of hepatocellular carcinoma in Japan: Consensus-Based Clinical Practice Guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis 2011; 29 (03) 339-364
    CrossrefPubMedGoogle Scholar
  • 13 Silva MA, Hegab B, Hyde C, Guo B, Buckels JA, Mirza DF. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut 2008; 57 (11) 1592-1596
    CrossrefPubMedGoogle Scholar
  • 14 Sherman CB, Zhao W, Corley DA, Guy J. Utilization and accuracy of biopsy in patients with hepatocellular carcinoma in a community based setting. J Clin Gastroenterol Treat 2016; 2: 26
    PubMedGoogle Scholar
  • 15 Arif-Tiwari H, Kalb B, Chundru S. , et al. MRI of hepatocellular carcinoma: an update of current practices. Diagn Interv Radiol 2014; 20 (03) 209-221
    CrossrefPubMedGoogle Scholar
  • 16 Darnell A, Forner A, Rimola J. , et al. Liver Imaging Reporting and Data System with MR imaging: evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 2015; 275 (03) 698-707
    CrossrefPubMedGoogle Scholar
  • 17 Santillan CS, Tang A, Cruite I, Shah A, Sirlin CB. Understanding LI-RADS: a primer for practical use. Magn Reson Imaging Clin N Am 2014; 22 (03) 337-352
    CrossrefPubMedGoogle Scholar
  • 18 Krinsky GA, Lee VS, Theise ND. , et al. Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 2001; 219 (02) 445-454
    CrossrefPubMedGoogle Scholar
  • 19 Tanabe M, Kanki A, Wolfson T. , et al. Imaging outcomes of Liver Imaging Reporting and Data System version 2014 category 2, 3, and 4 observations detected at CT and MR imaging. Radiology 2016; 281 (01) 129-139
    CrossrefPubMedGoogle Scholar
  • 20 Shah A, Tang A, Santillan C, Sirlin C. Cirrhotic liver: what's that nodule? The LI-RADS approach. J Magn Reson Imaging 2016; 43 (02) 281-294
    CrossrefPubMedGoogle Scholar
  • 21 Zhao W, Li W, Yi X. , et al. Diagnostic value of liver imaging reporting and data system MRI on primary hepatocellular carcinoma [in Chinese]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016; 41 (04) 380-387
    PubMedGoogle Scholar
  • 22 Choi J-Y, Cho HC, Sun M, Kim HC, Sirlin CB. Indeterminate observations (liver imaging reporting and data system category 3) on MRI in the cirrhotic liver: fate and clinical implications. AJR Am J Roentgenol 2013; 201 (05) 993-1001
    CrossrefPubMedGoogle Scholar
  • 23 An C, Rakhmonova G, Choi J-Y, Kim M-J. Liver imaging reporting and data system (LI-RADS) version 2014: understanding and application of the diagnostic algorithm. Clin Mol Hepatol 2016; 22 (02) 296-307
    CrossrefPubMedGoogle Scholar
  • 24 Burke LM, Sofue K, Alagiyawanna M. , et al. Natural history of liver imaging reporting and data system category 4 nodules in MRI. Abdom Radiol (NY) 2016; 41 (09) 1758-1766
    CrossrefPubMedGoogle Scholar
  • 25 Toyoda H, Kumada T, Tada T, Sone Y, Kaneoka Y, Maeda A. Tumor markers for hepatocellular carcinoma: simple and significant predictors of outcome in patients with HCC. Liver Cancer 2015; 4 (02) 126-136
    CrossrefPubMedGoogle Scholar
  • 26 Brancatelli G, Federle MP, Blachar A, Grazioli L. Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 2001; 219 (01) 69-74
    CrossrefPubMedGoogle Scholar
  • 27 Prasad SR, Wang H, Rosas H. , et al. Fat-containing lesions of the liver: radiologic-pathologic correlation. Radiographics 2005; 25 (02) 321-331
    CrossrefPubMedGoogle Scholar
  • 28 Hope TA, Fowler KJ, Sirlin CB. , et al. Hepatobiliary agents and their role in LI-RADS. Abdom Imaging 2015; 40 (03) 613-625
    CrossrefPubMedGoogle Scholar