Performing liver imaging at a high level: quality and adequacy in LI-RADS

Imaging is critical to HCC management, including surveillance, diagnosis, staging, and treatment response assessment, which requires it be performed consistently at a high level. The Liver Imaging Reporting and Data System (LI-RADS) was developed to standardize the acquisition, interpretation, and reporting of liver imaging, but until now, has not addressed the essential component of exam quality and adequacy. In this manuscript, we discuss the concepts of quality and adequacy and their clinical significance in the setting of HCC diagnostic imaging and treatment response assessment. We describe prior and current efforts to improve image quality and adequacy. We review common sources of image degradation that need to be addressed and the rationale behind LI-RADS technical recommendations. Finally, we offer a glimpse into preliminary efforts to develop an adequacy scoring system and make a call to action for all stakeholders to contribute to this important goal.