Knowledge, attitudes and current practices regarding LI-RADS^®: A survey from 14 countries in sub-Saharan Africa

Hepatocellular carcinoma (HCC) is highly prevalent in sub-Saharan Africa (SSA). LI-RADS^® is a standardised system for imaging-based diagnosis and characterisation of HCC.

This study assessed knowledge, attitudes and current practices related to LI-RADS in SSA, with a view to identifying barriers to its utilisation and informing targeted educational interventions.

A 21-item anonymous electronic questionnaire was distributed to medical professionals in SSA using the SurveyMonkey online platform. Knowledge, attitudes and current practices regarding LI-RADS^® were assessed. Data were analysed using descriptive statistics, and comparisons were made between radiologists and non-radiologists.

There were 134 respondents from 14 of the 34 SSA countries. Radiologists significantly outperformed non-radiologists in LI-RADS^® knowledge, particularly regarding its purpose (65.6% vs 38.2%, p = 0.0007), arterial phase hyperenhancement definition (90.3% vs 59.8%, p = 0.004) and size criteria (77.4% vs 45.1%, p = 0.003) for diagnosing hepatocellular carcinoma (HCC). However, 43.8% of radiologists and 63.4% of non-radiologists did not recognise the limitations of LI-RADS^®. Only 34.3% stated that LI-RADS^® was their reporting standard and 29.1% of the respondents indicated that less than 25% of their radiological reports adhered to LI-RADS^®. The majority (78.3%) of participants stated they preferred radiology reports for high-risk liver lesions to be LI-RADS^®-standardised. The two main barriers to adopting LI-RADS^® included lack of consistency (44.8%) and unfamiliarity with the reporting system (27.6%).

Although LI-RADS^® remains the preferred reporting system for HCC, there are significant gaps in its knowledge and implementation across SSA.

This survey highlights the needs for targeted educational initiatives and improved training to enhance the adoption and use of LI-RADS^® in SSA.