LI-RADS Imaging Criteria for HCC Diagnosis and Treatment: Emerging Evidence

The purpose of this study is to review the recent literature analyzing the performance of Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic and treatment response algorithm (TRA) for initial diagnosis and assessment of hepatocellular carcinoma (HCC) following locoregional therapy (LRT). LI-RADS is a comprehensive tool for assessment and reporting of observations in patients at risk of developing HCC. Since HCC is predominantly an imaging diagnosis, it is important to achieve a high sensitivity and specificity for each LR category. Therefore, a multitude of studies have been published over the recent years illustrating the diagnostic yield of both the diagnostic and treatment response algorithms. In addition, the role of abbreviated MRI for screening has also been studied recently. LI-RADS diagnostic algorithm has been validated by a number of recent studies that have provided a high diagnostic reliability for categorizing each observation, when using major as well as combination of major and ancillary features. In addition, LI-RADS TRA is being validated by the emerging literature providing promising results for treatment of HCC following ablation and nonradiation-based arterial therapies. However, further insight and in depth research is required to validate the imaging appearance of radiation-based therapies as well as utilization of ancillary features for response assessment after locoregional therapy.