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CT/MRI LI-RADS 2024 Update: Treatment Response Assessment.

Anum Aslam1, Victoria Chernyak1, Frank H Miller1

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Summary

The LI-RADS TRA algorithm aids in assessing liver cancer treatment response but needs refinement. The 2024 update aims to improve accuracy for various local-regional therapies (LRT) in hepatocellular carcinoma management.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Hepatocellular carcinoma (HCC) incidence is rising, increasing the use of local-regional therapy (LRT).
  • The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Assessment (TRA) algorithm standardizes post-LRT tumor assessment.
  • Accurate response assessment is crucial for treatment planning, including downstaging, bridging to transplant, definitive treatment, and palliation.

Purpose of the Study:

  • To review the challenges and limitations of the 2017 LI-RADS TRA algorithm.
  • To discuss refinements in the updated 2024 LI-RADS algorithm for CT/MRI.
  • To highlight the need for evidence-based and expert-based improvements in assessing treatment response after LRT.

Main Methods:

  • Review of existing literature on the LI-RADS TRA algorithm performance.
  • Analysis of current evidence regarding algorithm accuracy for different LRT modalities.
  • Discussion of proposed changes and validations for the 2024 LI-RADS TRA algorithm.

Main Results:

  • The LI-RADS TRA algorithm shows good performance for arterial embolic and loco-ablative therapies.
  • Algorithm performance is fair for radiation-based therapies, with limited validation data.
  • Refinements are necessary to enhance diagnostic accuracy across diverse LRT types.

Conclusions:

  • The LI-RADS TRA algorithm requires ongoing refinement to improve accuracy in assessing HCC treatment response.
  • The 2024 update introduces changes aimed at addressing limitations of the previous version.
  • Further research and validation are essential, particularly for radiation-based therapies.