Liver Imaging Reporting and Data System Version 2018: Impact on Categorization and Hepatocellular Carcinoma Staging

Area of Science:

• Radiology
• Hepatology
• Oncology

Background:

• Accurate liver lesion characterization is crucial for patient management and liver transplantation eligibility.
• The Liver Imaging Reporting and Data System (LI-RADS) provides standardized criteria for categorizing liver lesions on imaging.
• The Organ Procurement and Transplantation Network (OPTN) has its own criteria for liver allocation.

Purpose of the Study:

• To compare the concordance of lesion categorization and radiologic T staging between LI-RADS versions 2017 and 2018, and OPTN criteria.
• To evaluate the impact of LI-RADS updates on T staging for hepatocellular carcinoma.

Main Methods:

• Retrospective analysis of MRI and CT reports using a standardized LI-RADS macro.
• Extraction of major features (size, enhancement, washout, capsule, growth) for LR-3, LR-4, and LR-5 observations.
• Categorization and T staging using LI-RADS v2017, v2018, and OPTN criteria, followed by descriptive comparison.

Main Results:

• LI-RADS v2018 up-categorized 40.1% of LR-4 lesions to LR-5 compared to v2017, while 2.0% were down-categorized.
• LI-RADS v2018 resulted in higher T stages than v2017 in 12.3% of patients.
• Significant discrepancies were observed in T staging between LI-RADS versions and OPTN criteria, with 15.1% of patients upstaged by LI-RADS v2018 compared to OPTN.

Conclusions:

• Updates in LI-RADS criteria between 2017 and 2018 significantly altered lesion categorization and T staging.
• These changes introduce variability in T staging compared to both previous LI-RADS versions and OPTN criteria.
• Further research is needed to harmonize LI-RADS and OPTN staging for improved clinical decision-making in liver disease management.