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Semin Liver Dis 2022; 42(01): 104-111
DOI: 10.1055/s-0041-1732356
Review Article

Liver Imaging Reporting and Data System: Review of Pros and Cons

Eleonora Terzi
1   Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
,
Carmen Ayuso
2   Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
,
Fabio Piscaglia
1   Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
,
Jordi Bruix
3   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
4   Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Abstract

The American College of Radiology has released the Liver Imaging Reporting and Data System (LI-RADS) scheme which categorizes focal liver lesions (FLLs) in patients at risk for hepatocellular carcinoma (HCC) according to the degree of risk of nodules to be HCC. It subgroups FLL in LR-1 (definitely benign), LR-2 (probably benign), LR-3 (intermediate probability of malignancy), LR-4 (probably HCC), LR-5 (definitely HCC), and LR-M (probable malignancy not specific for HCC). Computed tomography/magnetic resonance imaging (CT/MRI) and contrast enhanced ultrasound (CEUS) LI-RADS diagnostic algorithm have the goal to standardize the acquisition, interpretation, reporting, and data collection for imaging examinations in patients at risk for HCC. Nevertheless, there remain controversial issues that should be dealt with. The aim of this review is to discuss the pros and cons of the interpretation and reporting part of CT/MRI and CEUS LI-RADS diagnostic algorithm to permit future refinements of the scheme and optimize patient and nodule management.

Keywords

Liver Imaging Reporting and Data System (LI-RADS) - focal liver lesion (FLL) - hepatocellular carcinoma (HCC) - cirrhosis - contrast enhanced ultrasound (CEUS)


Publication History

Article published online:
23 July 2021

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  • References

  • 1 Marrero JA, Kulik LM, Sirlin CB. et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2018; 68 (02) 723-750
    Google Scholar
  • 2 McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology 2021; 73 (Suppl. 01) 4-13
    Google Scholar
  • 3 Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet 2018; 391 (10127): 1301-1314
    CrossrefPubMedGoogle Scholar
  • 4 Navin PJ, Venkatesh SK. Hepatocellular carcinoma: state of the art imaging and recent advances. J Clin Transl Hepatol 2019; 7 (01) 72-85
    CrossrefPubMedGoogle Scholar
  • 5 Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014; 272 (03) 635-654
    CrossrefPubMedGoogle Scholar
  • 6 ACR. Accessed July 8, 2021 at: https://www.acr.org/Quality-Safety/Resources/LIRADS
    Google Scholar
  • 7 Tang A, Singal AG, Mitchell DG. et al. Introduction to the liver imaging reporting and data system for hepatocellular carcinoma. Clin Gastroenterol Hepatol 2019; 17 (07) 1228-1238
    CrossrefPubMedGoogle Scholar
  • 8 ACR. CEUS LI-RADS® v2017. Accessed 14 Sept 2020 at: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/CEUS-LI-RADS-v2017
    Google Scholar
  • 9 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69 (01) 182-236
    CrossrefPubMedGoogle Scholar
  • 10 Vogel A, Cervantes A, Chau I. et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019; 30 (05) 871-873
    CrossrefPubMedGoogle Scholar
  • 11 Benson AB, D'Angelica MI, Abbott DE. et al. Guidelines insights: hepatobiliary cancers, version 2.2019. J Natl Compr Canc Netw 2019; 17 (04) 302-310
    CrossrefPubMedGoogle Scholar
  • 12 Bolondi L, Sofia S, Siringo S. et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut 2001; 48 (02) 251-259
    CrossrefPubMedGoogle Scholar
  • 13 https://www.awmf.org/leitlinien/detail/ll/032–053OL.html
  • 14 Kokudo N, Takemura N, Hasegawa K. et al. Clinical practice guidelines for hepatocellular carcinoma: The Japan Society of Hepatology 2017 (4th JSH-HCC guidelines) 2019 update. Hepatol Res 2019; 49 (10) 1109-1113
    CrossrefPubMedGoogle Scholar
  • 15 Bolondi L, Cillo U, Colombo M. et al; Italian Association for the Study of the Liver (AISF), AISF Expert Panel, AISF Coordinating Committee. Position paper of the Italian Association for the Study of the Liver (AISF): the multidisciplinary clinical approach to hepatocellular carcinoma. Dig Liver Dis 2013; 45 (09) 712-723
    CrossrefPubMedGoogle Scholar
  • 16 Omata M, Lesmana LA, Tateishi R. et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4 (02) 439-474
    CrossrefPubMedGoogle Scholar
  • 17 Sherman M, Burak K, Maroun J. et al. Multidisciplinary Canadian consensus recommendations for the management and treatment of hepatocellular carcinoma. Curr Oncol 2011; 18 (05) 228-240
    CrossrefPubMedGoogle Scholar
  • 18 Reig M, Forner A, Ávila MA. et al. Diagnóstico y tratamiento del carcinoma hepatocelular. Actualización del documento de consenso de la AEEH, AEC, SEOM, SERAM, SERVEI, y SETH [Diagnosis and treatment of hepatocellular carcinoma. Update of the consensus document of the AEEH, AEC, SEOM, SERAM, SERVEI, and SETH]. Med Clin (Barc) 2021; 156 (09) 463.e1-463.e30
    CrossrefPubMedGoogle Scholar
  • 19 Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42 (05) 1208-1236
    CrossrefPubMedGoogle Scholar
  • 20 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
  • 21 de Sio I, Iadevaia MD, Vitale LM. et al. Optimized contrast-enhanced ultrasonography for characterization of focal liver lesions in cirrhosis: a single-center retrospective study. United European Gastroenterol J 2014; 2 (04) 279-287
    CrossrefPubMedGoogle Scholar
  • 22 Strobel D, Bernatik T, Blank W. et al. Diagnostic accuracy of CEUS in the differential diagnosis of small (≤ 20 mm) and subcentimetric (≤ 10 mm) focal liver lesions in comparison with histology. Results of the DEGUM multicenter trial. Ultraschall Med 2011; 32 (06) 593-597
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Yuan MX, Li R, Zhang XH. et al. Factors affecting the enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and their pathological correlations in patients with a single lesion. Ultraschall Med 2016; 37 (06) 609-618
    PubMedGoogle Scholar
  • 24 Wildner D, Bernatik T, Greis C, Seitz K, Neurath MF, Strobel D. CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients - early or late washout matters: a subanalysis of the DEGUM multicenter trial. Ultraschall Med 2015; 36 (02) 132-139
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Liu GJ, Wang W, Lu MD. et al. Contrast-enhanced ultrasound for the characterization of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Liver Cancer 2015; 4 (04) 241-252
    CrossrefPubMedGoogle Scholar
  • 26 Wildner D, Pfeifer L, Goertz RS. et al. Dynamic contrast-enhanced ultrasound (DCE-US) for the characterization of hepatocellular carcinoma and cholangiocellular carcinoma. Ultraschall Med 2014; 35 (06) 522-527
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Claudon M, Dietrich CF, Choi BI. et al; World Federation for Ultrasound in Medicine, European Federation of Societies for Ultrasound. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39 (02) 187-210
    CrossrefPubMedGoogle Scholar
  • 28 Piscaglia F, Kudo M, Han KH, Sirlin C. Diagnosis of hepatocellular carcinoma with non-invasive imaging: a plea for worldwide adoption of standard and precise terminology for describing enhancement criteria. Ultraschall Med 2017; 38 (01) 9-11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Terzi E, Iavarone M, Pompili M. et al; CEUS LI-RADS Italy study group collaborators. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1,006 nodules. J Hepatol 2018; 68 (03) 485-492
    CrossrefPubMedGoogle Scholar
  • 30 Vilana R, Forner A, Bianchi L. et al. Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound. Hepatology 2010; 51 (06) 2020-2029
    CrossrefPubMedGoogle Scholar
  • 31 Elsayes KM, Kielar AZ, Agrons MM. et al. Liver imaging reporting and data system: an expert consensus statement. J Hepatocell Carcinoma 2017; 4: 29-39
    CrossrefPubMedGoogle Scholar
  • 32 van der Pol CB, Lim CS, Sirlin CB. et al. Accuracy of the liver imaging reporting and data system in computed tomography and magnetic resonance image analysis of hepatocellular carcinoma or overall malignancy-a systematic review. Gastroenterology 2019; 156 (04) 976-986
    CrossrefPubMedGoogle Scholar
  • 33 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
  • 34 Ehman EC, Behr SC, Umetsu SE. et al. Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. Abdom Radiol (NY) 2016; 41 (05) 963-969
    CrossrefPubMedGoogle Scholar
  • 35 Corwin MT, Fananapazir G, Jin M, Lamba R, Bashir MR. Differences in liver imaging and reporting data system categorization between MRI and CT. AJR Am J Roentgenol 2016; 206 (02) 307-312
    CrossrefPubMedGoogle Scholar
  • 36 Terzi E, Giamperoli A, Sansone V. et al. CEUS pattern of hepatocellular carcinoma: prognostic implication. The International Liver Congress 2019 by EASL. Londra, 10 - 14 Aprile 2019. J Hepatol 2019; 70 (Suppl 1): e846
    PubMedGoogle Scholar
  • 37 Forner A, Vilana R, Bianchi L. et al. Lack of arterial hypervascularity at contrast-enhanced ultrasound should not define the priority for diagnostic work-up of nodules <2 cm. J Hepatol 2015; 62 (01) 150-155
    CrossrefPubMedGoogle Scholar
  • 38 Cucchetti A, Vivarelli M, Piscaglia F. et al. Tumor doubling time predicts recurrence after surgery and describes the histological pattern of hepatocellular carcinoma on cirrhosis. J Hepatol 2005; 43 (02) 310-316
    CrossrefPubMedGoogle Scholar
  • 39 Chen WT, Fernandes ML, Lin CC, Lin SM. Delay in treatment of early-stage hepatocellular carcinoma using radiofrequency ablation may impact survival of cirrhotic patients in a surveillance program. J Surg Oncol 2011; 103 (02) 133-139
    CrossrefPubMedGoogle Scholar
  • 40 Forner A, Vilana R, Ayuso C. et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47 (01) 97-104
    CrossrefPubMedGoogle Scholar
  • 41 Rimola J, Forner A, Tremosini S. et al. Non-invasive diagnosis of hepatocellular carcinoma ≤ 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 2012; 56 (06) 1317-1323
    CrossrefPubMedGoogle Scholar
  • 42 Bruix J, Ayuso C. Diagnosis of hepatic nodules in patients at risk for hepatocellular carcinoma: LI-RADS probability versus certainty. Gastroenterology 2019; 156 (04) 860-862
    CrossrefPubMedGoogle Scholar
  • 43 Terzi E, Iavarone M, Pompili M. et al. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter retrospective study of 1,006 nodules. J Hepatol 2018; 68: 485-492
    CrossrefPubMedGoogle Scholar
  • 44 van der Pol CB, Lim CS, Sirlin CB. et al. Accuracy of the liver imaging reporting and data system in computed tomography and magnetic resonance image analysis of hepatocellular carcinoma or overall malignancy-a systematic review. Gastroenterology 2019; 156: 976-986
    CrossrefPubMedGoogle Scholar