Standardized Reporting of HCC with LI-RADS and mRECIST: Update on the Situation in Germany

Abstract

Background

Online survey about the current status of CT protocols in hepatocellular carcinoma (HCC) in the year 2023/2024. Moreover, the usage of structured reporting using LI-RADS and mRECIST was surveyed and the results were compared with a survey from 2020.

Method

Radiologists working in outpatient or inpatient care in Germany were invited. The survey was conducted between 10/2022 and 06/2023 and between 06/2024 and 08/2024. HCC-related questions were asked regarding the commonly used imaging modalities, body coverage, and contrast phases in CT, as well as the usage of structured assessment and treatment response using mRECIST and LI-RADS.

Results

More than half of the participants stated that they “frequently” perform imaging of HCC. In the CT protocol, acquisition of a pre-contrast phase was widespread. While a late arterial and a portal venous contrast phase was acquired in most cases, a delayed phase was used much less frequently (at small and medium-sized hospitals only in 26.5%). For staging, LI-RADS was used in structured reports in only 13%; for response monitoring mRECIST was used at university hospitals in only 26.5% and LI-RADS in 14.7%, whereas these have been almost never used in routine practice at all other sites. The main reasons given for the lack of application were the expenditure of time, the lack of reporting templates, problems with integration into the IT infrastructure and a lack of reimbursement.

Conclusion

The recommendation of a three phase CT examination in late arterial, portal venous, and delayed phase for HCC diagnostics according to LI-RADS is only partially implemented in Germany. Structured reporting for staging and response monitoring using LI-RADS and mRECIST was at a similarly low level in Germany in 2023 compared to 2020. Possible solutions include the development and distribution of online educational resources, structured reporting templates, and inexpensive IT solutions.

Key Points

• The CT protocols in HCC diagnostics in Germany differ considerably with regard to the contrast phases acquired.

• Definition of a late arterial (approx. 15–20s p.i.; 5–15s after aortic peak), portal venous (approx. 60–80s p.i.) and delayed phase (2–5min p.i.) as well as a pre-contrast phase only after TACE may improve quality of CT diagnostics of HCC.

• The use of structured reporting using LI-RADS, LR-TR and mRECIST in HCC remained low in 2023/2024, similar to 2020.

• The use of LI-RADS and mRECIST could be improved by providing online educational resources, structured reporting templates, and inexpensive IT solutions.

Citation Format

• Nelles C, Ristow I, Juchems MS et al. Standardized Reporting of HCC with LI-RADS and mRECIST: Update on the Situation in Germany. Rofo 2025; DOI 10.1055/a-2438-1670

Keywords

staging - Liver Imaging Reporting and Data System (LI-RADS) - hepatocellular carcinoma (HCC) - modified RECIST (mRECIST)

Publication History

Received: 06 May 2024

Accepted after revision: 28 September 2024

Article published online:
23 January 2025

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