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Update on the Liver Imaging Reporting and Data System: What the Pathologist Needs to Know
An Tang1, Mark A Valasek, Claude B Sirlin
1*Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM) †Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada ‡Department of Pathology §Liver Imaging Group, Department of Radiology, University of California, San Diego, CA.
The Liver Imaging Reporting and Data System (LI-RADS) standardizes imaging for hepatocellular carcinoma (HCC) diagnosis in at-risk patients. While effective for progressed HCC, it has limitations in detecting early-stage disease.
Area of Science:
- Hepatology
- Radiology
- Pathology
Background:
- Hepatocellular carcinoma (HCC) diagnosis often relies on noninvasive imaging.
- Standardized reporting for HCC imaging has been lacking until recently.
- The Liver Imaging Reporting and Data System (LI-RADS) was developed for standardized HCC diagnosis.
Purpose of the Study:
- To review the fundamental concepts of LI-RADS.
- To highlight LI-RADS aspects crucial for pathologists.
- To compare LI-RADS with other radiology-based diagnostic systems.
Main Methods:
- Review of LI-RADS categories, diagnostic algorithm, and features.
- Comparison of LI-RADS with other diagnostic systems (target population, users, categorization, imaging methods).
Main Results:
- LI-RADS provides standardized terminology and reporting for HCC diagnosis in at-risk patients.
- LI-RADS and similar systems excel in diagnosing progressed HCC with high specificity but modest sensitivity.
- Detection and characterization of small (<1 cm) HCC nodules remain challenging for imaging systems.
Conclusions:
- LI-RADS is a valuable tool for standardized HCC diagnosis, particularly for progressed disease.
- Current imaging systems, including LI-RADS, have limited sensitivity for early HCC detection.
- Pathologist input is vital for the ongoing evolution and enhancement of LI-RADS reporting.
