A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls

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 p...

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Published inDiagnostics (Basel) Vol. 12; no. 7; p. 1655
Main Authors De Muzio, Federica, Grassi, Francesca, Dell’Aversana, Federica, Fusco, Roberta, Danti, Ginevra, Flammia, Federica, Chiti, Giuditta, Valeri, Tommaso, Agostini, Andrea, Palumbo, Pierpaolo, Bruno, Federico, Cutolo, Carmen, Grassi, Roberta, Simonetti, Igino, Giovagnoni, Andrea, Miele, Vittorio, Barile, Antonio, Granata, Vincenza
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 07.07.2022
MDPI
Subjects
Algorithms
Cholangiocarcinoma
Clinical medicine
Cysts
Diagnosis
Diagnosis, Differential
Evaluation
Hepatitis
Hepatoma
LI-RADS
liver
Liver cancer
Liver diseases
Magnetic resonance imaging
Medical screening
Methods
Patients
Radiology
Radiology, Medical
Review
Surveillance
Ultrasonic imaging
Working groups
Italy
LI-RADS
liver
diagnosis
Online AccessGet full text
ISSN2075-4418
2075-4418
DOI10.3390/diagnostics12071655

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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.
AbstractList 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.
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.
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.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.
Audience Academic
Author Danti, Ginevra
Simonetti, Igino
Agostini, Andrea
Barile, Antonio
Flammia, Federica
Granata, Vincenza
Grassi, Roberta
Miele, Vittorio
Bruno, Federico
Chiti, Giuditta
De Muzio, Federica
Giovagnoni, Andrea
Grassi, Francesca
Palumbo, Pierpaolo
Dell’Aversana, Federica
Valeri, Tommaso
Fusco, Roberta
Cutolo, Carmen
AuthorAffiliation 11 Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; igino.simonetti@istitutotumori.na.it (I.S.); v.granata@istitutotumori.na.it (V.G.)
7 Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
8 Area of Cardiovascular and Interventional Imaging, Department of Diagnostic Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
2 Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; francesca.grassi1@studenti.unicampania.it (F.G.); federica.dellaversana@studenti.unicampania.it (F.D.); roberta.grassi@policliniconapoli.it (R.G.)
4 Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; ginevra.danti@gmail.com (G.D.); federicaflammia91@gmail.com (F.F.); giudittachiti@gmail.com (G.C.); vmiele@sirm.org (V.M.)
5 Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Mi
AuthorAffiliation_xml – name: 2 Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; francesca.grassi1@studenti.unicampania.it (F.G.); federica.dellaversana@studenti.unicampania.it (F.D.); roberta.grassi@policliniconapoli.it (R.G.)
– name: 8 Area of Cardiovascular and Interventional Imaging, Department of Diagnostic Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
– name: 3 Medical Oncology Division, Igea SpA, 80013 Naples, Italy
– name: 9 Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy; abarile63@gmail.com
– name: 1 Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; demuziofederica@gmail.com
– name: 6 Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; t.valeri@univpm.it (T.V.); a.agostini@staff.univpm.it (A.A.); a.giovagnoni@univpm.it (A.G.)
– name: 5 Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; palumbopierpaolo89@gmail.com (P.P.); federico.bruno.1988@gmail.com (F.B.)
– name: 7 Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
– name: 4 Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; ginevra.danti@gmail.com (G.D.); federicaflammia91@gmail.com (F.F.); giudittachiti@gmail.com (G.C.); vmiele@sirm.org (V.M.)
– name: 11 Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; igino.simonetti@istitutotumori.na.it (I.S.); v.granata@istitutotumori.na.it (V.G.)
– name: 10 Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; carmencutolo@hotmail.it
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/35885561$$D View this record in MEDLINE/PubMed
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liver
diagnosis
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Snippet 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...
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SubjectTerms Algorithms
Cholangiocarcinoma
Clinical medicine
Cysts
Diagnosis
Diagnosis, Differential
Evaluation
Hepatitis
Hepatoma
LI-RADS
liver
Liver cancer
Liver diseases
Magnetic resonance imaging
Medical screening
Methods
Patients
Radiology
Radiology, Medical
Review
Surveillance
Ultrasonic imaging
Working groups
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Title A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls
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