Enhancing LI-RADS Through Semi-Automated Quantification of HCC Lesions

Hepatocellular carcinoma (HCC) is the most common primary malignant tumour of the liver. In a cirrhotic liver, each nodule larger than 10 mm demands further work-up using CT or MRI. The Liver Imaging Reporting and Data System (LI-RADS) is still based on visual assessment and measurements. The purpose of this study was to evaluate whether semi-automated quantification of visual LR-5 lesions is appropriate and can objectify HCC classification for personalized radiomic research.

A total of 52 HCC patients (median age 67 years, 17% females, 83% males) from a retrospective data collection were evaluated visually and compared by the results using an oncology software with features of LI-RADS-based structured tumour evaluation and documentation, semi-automated tumour segmentation, and texture analysis.

Software-based evaluation of non-rim arterial-phase hyperenhancement (APHE) and non-peripheral washout, as well as the LI-RADS-score, showed no statistically significant differences compared with visual assessment (p = 0.2, 0.7, 0.17), with a consensus between a human reader and the software approach in 98% (APHE), 89% (washout), and 93% (threshold growth) of cases, respectively. The software provided automated LI-RADS classification, structured reporting, and quantitative features for HCC registries and radiomic research.

The presented work may serve as an outlook for LI-RADS-based automated qualitative and quantitative evaluation. Future research may show if texture analysis can be used to foster personalized medical approaches in HCC.