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Tang A, Bashir MR, Corwin MT, Cruite I, Dietrich CF, Do RKG, Ehman EC, Fowler KJ, Hussain HK, Jha RC, Karam AR, Mamidipalli A, Marks RM, Mitchell DG, Morgan TA, Ohliger MA, Shah A, Vu KN, Sirlin CB. Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review. Radiology 2018; 286:29-48. [PMID: 29166245 PMCID: PMC6677284 DOI: 10.1148/radiol.2017170554] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- An Tang
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Mustafa R. Bashir
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Michael T. Corwin
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Irene Cruite
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Christoph F. Dietrich
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Richard K. G. Do
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Eric C. Ehman
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Kathryn J. Fowler
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Hero K. Hussain
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Reena C. Jha
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | | | - Adrija Mamidipalli
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Robert M. Marks
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Donald G. Mitchell
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Tara A. Morgan
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Michael A. Ohliger
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Amol Shah
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Kim-Nhien Vu
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
| | - For the LI-RADS Evidence Working Group
- From the Department of Radiology, Université de Montréal, 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2 (A.T., K.N.V.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Davis Medical Center, University of California, Sacramento, Calif (M.T.C.); Inland Imaging, Spokane, Wash (I.C.); Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany (C.F.D.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (R.K.G.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.C.E.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (H.K.H.); Department of Radiology, American University of Beirut, Beirut, Lebanon (H.K.H.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (R.C.J.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (A.R.K.); Department of Radiology, Liver Imaging Group, University of California San Diego, Calif (A.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.A.M., M.A.O.); Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.S.)
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Tanabe M, Kanki A, Wolfson T, Costa EAC, Mamidipalli A, Ferreira MPFD, Santillan C, Middleton MS, Gamst AC, Kono Y, Kuo A, Sirlin CB. Imaging Outcomes of Liver Imaging Reporting and Data System Version 2014 Category 2, 3, and 4 Observations Detected at CT and MR Imaging. Radiology 2016; 281:129-39. [PMID: 27115054 DOI: 10.1148/radiol.2016152173] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the proportion of untreated Liver Imaging Reporting and Data System (LI-RADS) version 2014 category 2, 3, and 4 observations that progress, remain stable, or decrease in category and to compare the cumulative incidence of progression in category. Materials and Methods In this retrospective, longitudinal, single-center, HIPAA-compliant, institutional review board-approved study, 157 patients (86 men and 71 women; mean age ± standard deviation, 59.0 years ± 9.7) underwent two or more multiphasic computed tomographic (CT) or magnetic resonance (MR) imaging examinations for hepatocellular carcinoma surveillance, with the first examination in 2011 or 2012. One radiologist reviewed baseline and follow-up CT and MR images (mean follow-up, 614 days). LI-RADS categories issued in the clinical reports by using version 1.0 or version 2013 were converted to version 2014 retrospectively; category modifications were verified with another radiologist. For index category LR-2, LR-3, and LR-4 observations, the proportions that progressed, remained stable, or decreased in category were calculated. Cumulative incidence curves for progression were compared according to baseline LI-RADS category (by using log-rank tests). Results All 63 index LR-2 observations remained stable or decreased in category. Among 166 index LR-3 observations, seven (4%) progressed to LR-5, and eight (5%) progressed to LR-4. Among 52 index LR-4 observations, 20 (38%) progressed to a malignant category. The cumulative incidence of progression to a malignant category was higher for index LR-4 observations than for index LR-3 or LR-2 observations (each P < .001) but was not different between LR-3 and LR-2 observations (P = .155). The cumulative incidence of progression to at least category LR-4 was trend-level higher for index LR-3 observations than for LR-2 observations (P = .0502). Conclusion Observations classified according to LI-RADS version 2014 categories are associated with different imaging outcomes. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Masahiro Tanabe
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Akihiko Kanki
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Tanya Wolfson
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Eduardo A C Costa
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Adrija Mamidipalli
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Marilia P F D Ferreira
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Cynthia Santillan
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Michael S Middleton
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Anthony C Gamst
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Yuko Kono
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Alexander Kuo
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
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