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Chernyak V. Up-to-Date Role of Liver Imaging Reporting and Data System in Hepatocellular Carcinoma. Surg Oncol Clin N Am 2024; 33:59-72. [PMID: 37945145 DOI: 10.1016/j.soc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This article overviews Liver Imaging Reporting and Data System (LI-RADS), a system that standardizes techniques, interpretation and reporting of imaging studies done for hepatocellular carcinoma surveillance, diagnosis, and locoregional treatment response assessment. LI-RADS includes 4 algorithms, each of which defines ordinal categories reflecting probability of the assessed outcome. The categories, in turn, guide patient management. The LI-RADS diagnostic algorithms provide diagnostic criteria for the entire spectrum of lesions found in at-risk patients. In addition, the use of LI-RADS in clinical care improves clarity of communication between radiologists and clinicians and may improve the performance of inexperienced users to the levels of expert liver imagers.
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Affiliation(s)
- Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
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Shahbazian H, Birnbaum J, Burns PJ, Shabanan SH, Kanmaniraja D, Reinus J, Kamel I, Sirlin CB, Chernyak V. Prevalence of different LI-RADS v2018 categories in high-risk patients undergoing CT- or MRI-based screening for hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:3696-3702. [PMID: 37725110 DOI: 10.1007/s00261-023-04040-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To estimate the prevalence of Liver Imaging Reporting and Data System (LI-RADS, LR) v2018 categories reported on CT or MRI performed for hepatocellular carcinoma (HCC) screening. MATERIALS AND METHODS This retrospective study included all reports for CT and MRI exams performed for HCC screening patients between 8/2018 and 4/2020. Patients with ultrasound, CT, or MRI of the abdomen within two years of the index exam were excluded. From each radiology report, we extracted number of reported liver observations, and LI-RADS v2018 category for each observation. RESULTS There were 329 patients (170 [52%] male, mean age 59 years [SD 12]), of whom 177 (54%) had MRI with gadoxetate, 72 (22%) had MRI with extracellular contrast, 7 (2%) had MRI with unspecified contrast, and 73 (22%) had CT. Of 329 patients, 199 (60%) had no reported observations; 130 patients had 166 reported observations: 114 (68.7%) LR-1, 8 (4.8%) LR-2, 21 (12.6%) LR-3, 6 (3.6%) LR-4, 13 (7.8%) LR-5, 3 (1.8%) LR-M, and 1 (0.6%) LR-TIV. Of 114 LR-1 observations, 78 (68%) were cysts, 17 (15%) were hemangiomas, 12 (11%) were vascular shunts, 3 (3%) were focal nodular hyperplasia, 2 (2%) were siderotic nodules, 1 (1%) was a lipoma, and 1 (1%) was biliary hamartoma. There were 23 observations with probably or definitely malignant categories (LR-4, LR-5, LR-M or LR- TIV), reported in 20/329 (6%) of patients. CONCLUSION In a cohort of at-risk patients undergoing contrast-enhanced CT/MRI for HCC screening, 60% of had no liver observations, and 6 % had probably or definitely malignant observations. IMPLICATIONS FOR PATIENT CARE The prevalence of LI-RADS v2018 categories on CT or MR exams used for HCC screening can help develop screening criteria and assess cost-effectiveness of surveillance strategies with CT and MRI.
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Affiliation(s)
- Haneyeh Shahbazian
- Department of Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jason Birnbaum
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
- Department of Radiology, Mount Sinai Hospital, New York, NY, USA
| | - Patricia J Burns
- Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | | | | | - John Reinus
- Department of Hepatology, Montefiore Medical Center, Bronx, NY, USA
| | - Ihab Kamel
- Department of Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Claude B Sirlin
- Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Kang JH, Kim NH, Kim DH, Choi Y, Choi JI. Ultrasound LI-RADS Visualization Scores on Surveillance Ultrasound for Hepatocellular Carcinoma: A Systematic Review With Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2205-2212. [PMID: 37517886 DOI: 10.1016/j.ultrasmedbio.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
We performed a systematic review and meta-analysis to determine the proportions of each surveillance ultrasound (US) visualization score for hepatocellular carcinoma based on the US Liver Imaging Reporting and Data System (LI-RADS) and to identify the factors associated with visualization score C. Original publications reporting US LI-RADS visualization scores were identified in MEDLINE and EMBASE from January 1, 2017, to November 25, 2022. The meta-analytic pooled proportion of each visualization score based on US examination was calculated using the DerSimonian‒Laird random-effects model. Subgroup meta-regression analyses were performed to explore study heterogeneity. US LI-RADS visualization scores were reported from a total of 25,698 US examinations across 12 studies. The pooled proportions of visualization scores A, B and C were 56.7% (95% confidence interval [CI]: 38.6-73.2%, I2 = 99.2%), 30.3% (95% CI: 21.5-40.7%, I2 = 98.8%) and 6.9% (95% CI: 3.9-11.7%, I2 = 97.7%), respectively. Significantly higher proportions of visualization score C were found in studies that exclusively enrolled cirrhosis patients and a study in which the disease etiology was non-alcoholic fatty liver disease (NAFLD) (p < 0.05). In addition, the pooled proportion of visualization score C was higher in studies with a mean or median body mass index >25 kg/m2 (10.7%, 95% CI: 4.3-24.3%). In conclusion, a substantial proportion of surveillance US examinations exhibited moderate to severe limitations on visualization. There was a tendency toward higher proportions of US LI-RADS visualization score C in patients with cirrhosis, NAFLD and obesity.
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Affiliation(s)
- Ji Hun Kang
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
| | - Yangsean Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
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Positive predictive value of LI-RADS US-3 observations: multivariable analysis of clinical and imaging features. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:271-281. [PMID: 36253490 DOI: 10.1007/s00261-022-03681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine how clinical and imaging features affect the positive predictive values (PPV) of US-3 observations. METHODS In this retrospective study, 10,546 adult patients who were high risk for hepatocellular carcinoma (HCC) from 2017 to 2021 underwent ultrasound screening/surveillance. Of these, 225 adult patients (100 women, 125 men) with an US-3 observation underwent diagnostic characterization with multiphasic CT (93; 41%), MRI (130; 58%), or contrast-enhanced ultrasound (2; 1%). US-3 observations included focal observations ≥ 10 mm in 216 patients and new venous thrombi in 9 patients. PPV with 95% confidence intervals were calculated using diagnostic characterization as the reference standard. Multivariable analysis of clinical and imaging features was performed to determine the strongest associations with cancer. RESULTS Overall PPV for an US-3 observation was 33% (27-39%) for at least intermediate probability of cancer (≥ LR-3) and 15% (10-20%) for at least probable cancer (≥ LR-4). At multivariable analysis, cirrhosis had the strongest effect size for at least probable cancer (p < 0.001; odds ratio OR 20.4), followed by observation size (p < 0.001; OR 2.65) and age (p = 0.004; OR 1.05). Alpha-fetoprotein, visualization score, and observation echogenicity were not statistically significant associations. Modality (MRI versus CT) did not affect PPV. Due to the large effect of cirrhosis, PPV was then stratified by the presence (n = 116; 52%) or absence (n = 109; 48%) of cirrhosis. For at least probable cancer (≥ LR-4), PPV increased from 4% (0-7%; non-cirrhotic) to 26% (18-34%; p < 0.001; cirrhosis). CONCLUSION Cirrhosis most strongly affects PPV of US-3 observations for at least probable cancer at diagnostic characterization among high-risk patients, increasing to 1 in 4 among cirrhotic patients from 1 in 25 among non-cirrhotic patients.
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De Muzio F, Grassi F, Dell’Aversana F, Fusco R, Danti G, Flammia F, Chiti G, Valeri T, Agostini A, Palumbo P, Bruno F, Cutolo C, Grassi R, Simonetti I, Giovagnoni A, Miele V, Barile A, Granata V. A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12071655. [PMID: 35885561 PMCID: PMC9319674 DOI: 10.3390/diagnostics12071655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Liver cancer is the sixth most detected tumor and the third leading cause of tumor death worldwide. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with specific risk factors and a targeted population. Imaging plays a major role in the management of HCC from screening to post-therapy follow-up. In order to optimize the diagnostic-therapeutic management and using a universal report, which allows more effective communication among the multidisciplinary team, several classification systems have been proposed over time, and LI-RADS is the most utilized. Currently, LI-RADS comprises four algorithms addressing screening and surveillance, diagnosis on computed tomography (CT)/magnetic resonance imaging (MRI), diagnosis on contrast-enhanced ultrasound (CEUS) and treatment response on CT/MRI. The algorithm allows guiding the radiologist through a stepwise process of assigning a category to a liver observation, recognizing both major and ancillary features. This process allows for characterizing liver lesions and assessing treatment. In this review, we highlighted both major and ancillary features that could define HCC. The distinctive dynamic vascular pattern of arterial hyperenhancement followed by washout in the portal-venous phase is the key hallmark of HCC, with a specificity value close to 100%. However, the sensitivity value of these combined criteria is inadequate. Recent evidence has proven that liver-specific contrast could be an important tool not only in increasing sensitivity but also in diagnosis as a major criterion. Although LI-RADS emerges as an essential instrument to support the management of liver tumors, still many improvements are needed to overcome the current limitations. In particular, features that may clearly distinguish HCC from cholangiocarcinoma (CCA) and combined HCC-CCA lesions and the assessment after locoregional radiation-based therapy are still fields of research.
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Affiliation(s)
- Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy;
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
| | - Federica Dell’Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Ginevra Danti
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Federica Flammia
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Giuditta Chiti
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Tommaso Valeri
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Andrea Agostini
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
- Area of Cardiovascular and Interventional Imaging, Department of Diagnostic Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
- Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy;
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Roberta Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (I.S.); (V.G.)
| | - Andrea Giovagnoni
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Vittorio Miele
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Antonio Barile
- Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy;
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (I.S.); (V.G.)
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Multicenter Study of ACR Ultrasound LI-RADS Visualization Scores on Serial Examinations: Implications for Changes in Surveillance Strategies. AJR Am J Roentgenol 2022; 219:445-452. [PMID: 35383486 DOI: 10.2214/ajr.22.27405] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: American College of Radiology Ultrasound LI-RADS includes the visualization score as a subjective measure of examination quality and expected level of sensitivity. Whether a single suboptimal visualization score warrants change in surveillance strategy is unknown. Objective: To determine the relative stability of visualization scores on serial surveillance ultrasound examinations in patients at risk for HCC. Methods: This retrospective study included patients at risk for HCC who underwent at least two HCC surveillance ultrasound examinations at one of three institutions between January 2017 and November 2020. Frequencies of score remaining unchanged after variable numbers of preceding examinations with the given score were determined. A mixed-effects logistic model was fitted to identify factors associated with a repeat score C (severe limitations) versus change to score A (no or minimal limitations) or score B (moderate limitations). Results: A total of 3169 patients underwent at least 2 ultrasound examinations, yielding a total of 9602 examinations. A total of 8030 (83.6%) examinations had score A, 1378 (14.4%) score B, and 194 (2.0%) score C. Frequency of score A was 88%, 91%, and 93% after 1, 2 and 3 consecutive prior examinations with score A. Frequency of score B was 45%, 48%, and 55% after 1, 2, and 3 consecutive prior examinations with score B. Frequency of score C was 42%, 67%, and 80% after 1, 2, and 3 consecutive prior examinations with score C. Among 109 examinations with score C in 91 patients with an available follow-up examination, no factor (including age, sex, severe steatosis, advanced cirrhosis, ascites, body mass index, and change in ultrasound machine, sonographer, or radiologist) was significantly associated with repeat score C (all p>.05). Although not statistically significant, presence of severe steatosis and advanced cirrhosis had the highest odds ratios (2.88 and 2.38, respectively) for repeat score C in multivariable analysis. Conclusion: Only 42% of patients with visualization score C on surveillances examination have score C on follow-up examination. Clinical Impact: The findings may inform decisions for alternative surveillance strategies in patients with visualization score C on ultrasound. This decision should consider the number of previous examinations with score C.
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Editor's Notebook: September 2021. AJR Am J Roentgenol 2021; 217:527-528. [PMID: 34415203 DOI: 10.2214/ajr.21.26336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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