Liver imaging reporting and data system (LI-RADS) v2018: Reliability and agreement for assessing hepatocellular carcinoma locoregional treatment response

Hepatocellular carcinoma (HCC) is the sixth most prevalent malignancy worldwide [1]. Although liver transplantation is one of the curative treatment options for patients with HCC, transplant waiting list led to an increase in the frequency of locoregional therapy [2,3].

Surgery, locoregional treatments including radiofrequency ablation (RFA), microwave ablation (MWA), transarterial chemoembolization (TACE), external radiation therapy and systemic therapies can be used alone or in combination for variable treatment plans including curative, downstaging, or palliative treatment [4,5]. The clinical response of locoregional treatment is assessed by dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) or computed tomography (CT) [6]. However, image interpretation can be difficult due to the various changes that occur following different types of locoregional treatment, and because of underlying liver cirrhosis with associated perfusion changes [7]. Thus, the presence of clear classification of the post locoregional treatment imaging features used for tumor viability assessment became mandatory to allow easy communication with other physicians and for proper decision making.

Diffusion-weighted imaging (DWI) provides information on the tumor's microenvironment and can aid in the diagnosis of viable HCC following locoregional therapy, since water facilitation increases in the nonviable necrotic HCC, while diffusion restriction usually persists in the viable treated HCC [8].

The 2017 and 2018 versions of the liver imaging reporting and data system (LI-RADS) introduced an algorithm for the evaluation of HCC after locoregional therapy. This algorithm defines certain imaging features for the categorization of lesions into three LI-RADS treatment response (LR-TR) categories, including: (i), LR-TR nonviable; (ii), equivocal; and (iii), viable [9,10]. The standardized reports should be a continuous process that is revised and updated as new information and data become available. To determine the reliability and agreement of the LR-TR v2018 and the added value of DWI for discrimination between viable and non-viable HCC lesions after locoregional treatment, more study is needed.

The purpose of this study was to assess the interobserver agreement and the reliability of LR-TR v2018 algorithm using DCE MRI and the added value of DWI for the diagnosis of viable HCC lesions after locoregional treatment.

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