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DOI: 10.1055/a-1990-5924
LI-RADS Made Easy
Artikel in mehreren Sprachen: English | deutsch![](https://www.thieme-connect.de/media/roefo/202306/lookinside/thumbnails/roefo-19905924_10-1055-a-1990-5924_en-1.jpg)
Abstract
Purpose The Liver Imaging Reporting and Data System (LI-RADS v2018) standardizes the interpretation and reporting of MDCT and MRI examinations in patients at risk for hepatocellular carcinoma (HCC).
Materials and Methods For focal liver lesions (called “observations”) it assigns categories (LR-1 to 5, LR-M, LR-TIV, LR-TR), which reflect the probability of benignity or malignancy (HCC or other non-HCC malignancies) of the respective observation. The categories assigned are based on major and ancillary image features, which have been developed by the American College of Radiology (ACR), revised several times (now v2018), and validated in many studies. The value of ancillary features to modify LI-RADS categories assigned to observations based on major features is shown.
Results This review summarizes the relevant CT and MRI features and presents a step-by-step approach for readers not familiar with LI-RADS on how to use the system. Relevant imaging features and the value of different modalities (contrast-enhanced CT, MRI with extracellular gadolinium chelates or liver-specific contrast agents) is explained.
Conclusion The widespread adoption of LI-RADS for CT/MRI reporting in high-risk patients would help to reduce inter-reader variability. It could improve communication between radiologists, oncologists, hepatologists, pathologists, and liver surgeons, and lead to better patient management.
Key points:
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LI-RADS has been developed and revised to address the need for improved diagnosis and standardized categorization of findings in chronic liver disease.
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CT/MRI LI-RADS consists of major criteria and ancillary features to classify observations.
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LI-RADS terminology helps to clarify the communication of liver observations between radiologists and referring physicians.
Citation Format
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Schima W, Kopf H, Eisenhuber E. LI-RADS made Easy. Fortschr Röntgenstr 2023; 195: 486 – 494
Publikationsverlauf
Eingereicht: 31. Januar 2022
Angenommen: 23. November 2022
Artikel online veröffentlicht:
01. Februar 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Yang JD, Hainaut P, Gores GJ. et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019; 16: 589-604
- 2 Erkan B, Meier J, Clark TJ. et al. Non-invasive diagnostic criteria of hepatocellular carcinoma: Comparison of diagnostic accuracy of updated LI-RADS with clinical practice guidelines of OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLSCG-NCC. PLoS One 2019; 14: e0226291
- 3 Kim TH, Kim SY, Tang A. et al. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma: 2018 update. Clin Mol Hepatol 2019; 25: 245-263
- 4 https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/LI-RADS-CT-MRI-v2018 Access Date: 11.01.2023
- 5 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: 129-139 DOI: 10.1148/radiol.2016152173.
- 6 Hong CW, Park CC, Mamidipalli A. et al. Longitudinal evolution of CT and MRI LI-RADS v2014 category 1, 2, 3, and 4 observations. Eur Radiol 2019; 29: 5073-5081 DOI: 10.1007/s00330-019-06058-2.
- 7 Choi JY, Cho HC, Sun M. et al. Indeterminate observations (liver imaging reporting and data system category 3) on MRI in the cirrhotic liver: fate and clinical implications. Am J Roentgenol 2013; 201: 993-1001 DOI: 10.2214/ajr.12.10007.
- 8 Ojeda PI, Hannan LM, Mieloszyk RJ. et al. Is There a Difference Between LI-RADS 3 to LI-RADS 5 Progression Assessment Using CT Versus MR? A Retrospective, Single-Center, Longitudinal Study of Patients Who Underwent 5082 Radiologic Examinations for Surveillance of Hepatocellular Carcinoma Over a 43-Month Period. Curr Probl Diagn Radiol 2021; DOI: 10.1067/j.cpradiol.2021.03.016.
- 9 Fraum TJ, Tsai R, Rohe E. et al. Differentiation of Hepatocellular Carcinoma from Other Hepatic Malignancies in Patients at Risk: Diagnostic Performance of the Liver Imaging Reporting and Data System Version 2014. Radiology 2018; 286: 158-172 DOI: 10.1148/radiol.2017170114.
- 10 Catania R, Chupetlovska K, Borhani AA. et al. Tumor in vein (LR-TIV) and liver imaging reporting and data system (LI-RADS) v2018: diagnostic features, pitfalls, prognostic and management implications. Abdom Radiol (NY) 2021; 46: 5723-5734 DOI: 10.1007/s00261-021-03270-x.
- 11 Potretzke TA, Tan BR, Doyle MB. et al. Imaging Features of Biphenotypic Primary Liver Carcinoma (Hepatocholangiocarcinoma) and the Potenzial to Mimic Hepatocellular Carcinoma: LI-RADS Analysis of CT and MRI Features in 61 Cases. Am J Roentgenol 2016; 207: 25-31 DOI: 10.2214/ajr.15.14997.
- 12 Lee S, Kim SS, Roh YH. et al. Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Liver Int 2020; 40: 1488-1497 DOI: 10.1111/liv.14424.
- 13 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 DOI: 10.1053/j.gastro.2018.11.020.
- 14 Darnell A, Rimola J, Belmonte E. et al. Evaluation of LI-RADS 3 category by magnetic resonance in US-detected nodules ≤ 2 cm in cirrhotic patients. Eur Radiol 2021; 31: 4794-4803 DOI: 10.1007/s00330-020-07457-6.
- 15 Lee YJ, Lee JM, Lee JS. et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology 2015; 275: 97-109 DOI: 10.1148/radiol.14140690.
- 16 Roberts LR, Sirlin CB, Zaiem F. et al. Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. Hepatology 2018; 67: 401-421 DOI: 10.1002/hep.29487.
- 17 Kim YY, Lee S, Shin J. et al. Diagnostic Performance of Liver Imaging Reporting and Data System Version 2017 Versus Version 2018 for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Comparative Studies. J Magn Reson Imaging 2021; 54: 1912-1919 DOI: 10.1002/jmri.27664.
- 18 Liang Y, Xu F, Guo Y. et al. Diagnostic performance of LI-RADS for MRI and CT detection of HCC: A systematic review and diagnostic meta-analysis. Eur J Radiol 2021; 134: 109404 DOI: 10.1016/j.ejrad.2020.109404.
- 19 Paisant A, Vilgrain V, Riou J. et al. Comparison of extracellular and hepatobiliary MR contrast agents for the diagnosis of small HCCs. J Hepatol 2020; 72: 937-945 DOI: 10.1016/j.jhep.2019.12.011.
- 20 Song JS, Choi EJ, Hwang SB. et al. LI-RADS v2014 categorization of hepatocellular carcinoma: Intraindividual comparison between gadopentetate dimeglumine-enhanced MRI and gadoxetic acid-enhanced MRI. Eur Radiol 2019; 29: 401-410 DOI: 10.1007/s00330-018-5559-z.
- 21 Min JH, Kim JM, Kim YK. et al. Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System. Hepatology 2018; 68: 2254-2266 DOI: 10.1002/hep.30122.
- 22 Semaan S, Vietti Violi N, Lewis S. et al. Hepatocellular carcinoma detection in liver cirrhosis: diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast vs. gadoxetic acid. Eur Radiol 2020; 30: 1020-1030 DOI: 10.1007/s00330-019-06458-4.
- 23 Rong D, He B, Tang W. et al. Comparison of Gadobenate-Enhanced MRI and Gadoxetate-Enhanced MRI for Hepatocellular Carcinoma Detection Using LI-RADS Version 2018: A Prospective Intraindividual Randomized Study. Am J Roentgenol 2021; DOI: 10.2214/ajr.21.26818.
- 24 Schima W. Editorial Comment: Which MRI Contrast Agent for Hepatocellular Carcinoma Diagnosis in LI-RADS? The Fog is Lifting. Am J Roentgenol 2021; DOI: 10.2214/ajr.21.27171.
- 25 Rimola J, Sapena V, Brancatelli G. et al. Reliability of extracellular contrast versus gadoxetic acid in assessing small liver lesions using liver imaging reporting and data system v.2018 and European association for the study of the liver criteria. Hepatology 2022; DOI: 10.1002/hep.32494.
- 26 Lee S, Kim SS, Roh YH. et al. Diagnostic Performance of CT/MRI Liver Imaging Reporting and Data System v2017 for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Liver Int 2020; 40: 1488-1497 DOI: 10.1111/liv.14424.
- 27 Van der Pol CB, McInnes MDF, Salameh JP. et al. CT/MRI and CEUS LI-RADS Major Features Association with Hepatocellular Carcinoma: Individual Patient Data Meta-Analysis. Radiology 2022; 302: 326-335 DOI: 10.1148/radiol.2021211244.
- 28 Marks RM, Masch WR, Chernyak V. LI-RADS: Past, Present, and Future, From the Am J Roentgenol Special Series on Radiology Reporting and Data Systems. Am J Roentgenol 2021; 216: 295-304 DOI: 10.2214/ajr.20.24272.
- 29 Ringe KI, Gut A, Grenacher L. et al. LI-RADS in the year 2020 – Are you already using it or still considering?. Rofo 2021; 193: 186-193 DOI: 10.1055/a-1212-5915.