The Liver Imaging Reporting and Data System (LI-RADS) is a recently developed classification aiming to improve the standardization of liver imaging assessment in patients at risk of developing hepatocellular carcinoma (HCC). The LI-RADS v2017 implemented new algorithms for ultrasound (US) screening and surveillance, contrast-enhanced US diagnosis and computed tomography/magnetic resonance imaging treatment response assessment. A minor update of LI-RADS was released in 2018 to comply with the American Association for the Study of the Liver Diseases guidance recommendations. The scope of this review is to provide a practical overview of LI-RADS v2018 focused both on the multimodality HCC diagnosis and treatment response assessment.
FerenciPFriedMLabrecqueD, et al.World Gastroenterology Organisation Guideline. Hepatocellular carcinoma (HCC): a global perspective. J Gastrointestin Liver Dis. 2010;19(3):311–317.
2.
Global Burden of Disease Liver Cancer Collaboration, AkinyemijuTAberaS, et al.The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the Global Burden of Disease Study 2015. JAMA Oncol. 2017;3(12):1683–1691.
3.
MarreroJAKulikLMSirlinCB, 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(2):723–750.
4.
ElsayesKMHookerJCAgronsMM, et al.2017 version of LI-RADS for CT and MR imaging: an update. Radiographics. 2017;37(7):1994–2017.
5.
KielarAZChernyakVBashirMR, et al.LI-RADS 2017: an update. J Magn Reson Imaging. 2018;47(6):1459–1474.
6.
BoschFXRibesJClériesRDíazM. Epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2005;9(2):191–211, v.
WilsonSRLyshchikAPiscagliaF, et al.CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY). 2018;43(1):127–142.
9.
KielarAZChernyakVBashirMR, et al.An update for LI-RADS: version 2018. Why so soon after version 2017?J Magn Reson Imaging. 2019;50(6):1990–1991.
10.
SantillanCFowlerKKonoYChernyakV. LI-RADS major features: CT, MRI with extracellular agents, and MRI with hepatobiliary agents. Abdom Radiol (NY). 2018;43(1):75–81.
11.
KokuboRSaitoKShirotaN, et al.A case of primary clear cell hepatocellular carcinoma comprised mostly of clear cells. Radiol Case Rep. 2019;14(11):1377–1381.
12.
TangABashirMRCorwinMT, et al.Evidence supporting LI-RADS major features for CT- and MR imaging-based diagnosis of hepatocellular carcinoma: a systematic review. Radiology. 2018;286(1):29–48.
13.
BruixJShermanM, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–1022.
14.
ChernyakVTangAFlusbergM, et al.LI-RADS((R)) ancillary features on CT and MRI. Abdom Radiol (NY). 2018;43(1):82–100.
15.
DarnellAFornerARimolaJ, 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(3):698–707.
16.
FurlanAMarinDAgnelloF, et al.Hepatocellular carcinoma presenting at contrast-enhanced multi-detector-row computed tomography or gadolinium-enhanced magnetic resonance imaging as a small (</=2 cm), indeterminate nodule: growth rate and optimal interval time for imaging follow-up. J Comput Assist Tomogr. 2012;36(1):20–25.
17.
MiyayamaSYamashiroMOkudaM, et al.Detection of corona enhancement of hypervascular hepatocellular carcinoma by C-arm dual-phase cone-beam CT during hepatic arteriography. Cardiovasc Intervent Radiol. 2011;34(1):81–86.
18.
KimYKLeeWJParkMJKimSHRhimHChoiD. Hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis: potential of DW imaging in predicting progression to hypervascular HCC. Radiology. 2012;265(1):104–114.
19.
Le MoigneFDurieuxMBancelB, et al.Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver. Magn Reson Imaging. 2012;30(5):656–665.
20.
RheeHKimMJParkYNChoiJSKimKS. Gadoxetic acid-enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria. J Magn Reson Imaging. 2012;35(2):393–398.
21.
ChoiSHByunJHLimYS, et al.Diagnostic criteria for hepatocellular carcinoma 3 cm with hepatocyte-specific contrast-enhanced magnetic resonance imaging. J Hepatol. 2016;64(5):1099–1107.
22.
CruiteISchroederMMerkleEMSirlinCB. Gadoxetate disodium-enhanced MRI of the liver: part 2, protocol optimization and lesion appearance in the cirrhotic liver. AJR Am J Roentgenol. 2010;195(1):29–41.
23.
Dioguardi BurgioMPiconeDCabibboGMidiriMLagallaR, Brancatelli G.MR-imaging features of hepatocellular carcinoma capsule appearance in cirrhotic liver: comparison of gadoxetic acid and gadobenate dimeglumine. Abdom Radiol (NY). 2016;41(8):1546–1554.
24.
SuhYJKimMJChoiJYParkYNParkMSKimKW. Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol. 2011;197(1):W44–W52.
25.
YoshidaTMatsueHOkazakiNYoshinoM. Ultrasonographic differentiation of hepatocellular carcinoma from metastatic liver cancer. J Clin Ultrasound. 1987;15(7):431–437.
26.
KutamiRNakashimaYNakashimaOShiotaKKojiroM. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol. 2000;33(2):282–289.
27.
HopeTAFowlerKJSirlinCB, et al.Hepatobiliary agents and their role in LI-RADS. Abdom Imaging. 2015;40(3):613–625.
28.
KozakaKKobayashiSYonedaN, et al.Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features. Eur Radiol. 2019;29(12):6489–6498.
29.
YonedaNMatsuiOKitaoA, et al.Benign hepatocellular nodules: hepatobiliary phase of gadoxetic acid-enhanced MR imaging based on molecular background. Radiographics. 2016;36(7):2010–2027.
30.
DooKWLeeCHChoiJWLeeJKimKAParkCM. “Pseudo washout” sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR Am J Roentgenol. 2009;193(6):W490–W496.
31.
ChongYSKimYKLeeMW, et al.Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol2012;67(8):766–773.
32.
KimRLeeJMShinCI, et al.Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol. 2016;26(6):1808–1817.
33.
BolondiL. Screening for hepatocellular carcinoma in cirrhosis. J Hepatol. 2003;39(6):1076–1084.
34.
Gambarin-GelwanMWolfDCShapiroRSchwartzMEMinAD. Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation. Am J Gastroenterol. 2000;95(6):1535–1538.
35.
SonJHChoiSHKimSY, et al., Validation of US Liver Imaging Reporting and Data System version 2017 in patients at high risk for hepatocellular carcinoma. Radiology. 2019;292(2):390–397.
36.
RodgersSKFetzerDTGabrielH, et al.Role of US LI-RADS in the LI-RADS algorithm. Radiographics. 2019;39(3):690–708.
37.
TerraultNALokASFMcMahonBJ, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 Hepatitis B guidance. Hepatology. 2018;67(4):1560–1599.
38.
MorganTAMaturenKEDahiyaN, et al.US LI-RADS: Ultrasound Liver Imaging Reporting and Data System for screening and surveillance of hepatocellular carcinoma. Abdom Radiol (NY). 2018;43(1):41–55.
39.
JangHJKimTKBurnsPNWilsonSR. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology. 2007;244(3):898–906.
40.
KielarAFowlerKJLewisS, et al., Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY). 2018;43(1):218–230.
41.
ChungWSLeeKHParkMS, et al.Enhancement patterns of hepatocellular carcinoma after transarterial chemoembolization using drug-eluting beads on arterial phase CT images: a pilot retrospective study. AJR Am J Roentgenol. 2012;199(2):349–359.
42.
EhmanECUmetsuSEOhligerMA, et al.Imaging prediction of residual hepatocellular carcinoma after locoregional therapy in patients undergoing liver transplantation or partial hepatectomy. Abdom Radiol (NY). 2016;41(11):2161–2168.
43.
KalliniJRillerFHGabrASalemRLewandowskiRJ. Hepatic imaging following intra-arterial embolotherapy. Abdom Radiol (NY). 2016;41(4):600–616.
44.
MerkleEMZechCJBartolozziC, et al.Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol. 2016;26(3):674–682.
45.
ShinagawaYSakamotoKFujimitsuR, et al.Pseudolesion of the liver observed on gadoxetate disodium-enhanced magnetic resonance imaging obtained shortly after transarterial chemoembolization for hepatocellular carcinoma. Jpn J Radiol. 2010;28(6):483–488.
46.
WatanabeHKanematsuMGoshimaS, et al.Is gadoxetate disodium-enhanced MRI useful for detecting local recurrence of hepatocellular carcinoma after radiofrequency ablation therapy?AJR Am J Roentgenol. 2012;198(3):589–595.
47.
TsudaMMajimaKYamadaTSaitouHIshibashiTTakahashiS. Hepatocellular carcinoma after radiofrequency ablation therapy: dynamic CT evaluation of treatment. Clin Imaging. 2001;25(6):409–415.
48.
SchimaWBa-SsalamahAKurtaranASchindlMGruenbergercT. Post-treatment imaging of liver tumours. Cancer Imaging. 2007;7(spec no A):S28–S36.
49.
ShynPBOlivaMRShahSHTatliSCatalanoPJSilvermanSG. MRI contrast enhancement of malignant liver tumours following successful cryoablation. Eur Radiol. 2012;22(2):398–403.
50.
KubotaKHisaNNishikawaT, et al.Evaluation of hepatocellular carcinoma after treatment with transcatheter arterial chemoembolization: comparison of Lipiodol-CT, power Doppler sonography, and dynamic MRI. Abdom Imaging. 2001;26(2):184–190.
51.
LeeSKimKAParkMSChoiSY. MRI findings and prediction of time to progression of patients with hepatocellular carcinoma treated with drug-eluting bead transcatheter arterial chemoembolization. J Korean Med Sci. 2015;30(7):965–973.
52.
WangXErinjeriJPJiaX, et al.Pattern of retained contrast on immediate postprocedure computed tomography (CT) after particle embolization of liver tumors predicts subsequent treatment response. Cardiovasc Intervent Radiol. 2013;36(4):1030–1038.
53.
IbrahimSMNikolaidisPMillerFH, et al.Radiologic findings following Y90 radioembolization for primary liver malignancies. Abdom Imaging. 2009;34(5):566–581.
54.
KimuraTTakahashiSKenjoM, et al.Dynamic computed tomography appearance of tumor response after stereotactic body radiation therapy for hepatocellular carcinoma: how should we evaluate treatment effects?Hepatol Res. 2013;43(7):717–727.
55.
KieransASMakkarJGunigantiP, et al.Validation of Liver Imaging Reporting and Data System 2017 (LI-RADS) criteria for imaging diagnosis of hepatocellular carcinoma. J Magn Reson Imaging. 2019;49(7):e205–e215.
