White paper of the Society of Abdominal Radiology hepatocellular carcinoma diagnosis disease-focused panel on LI-RADS v2018 for CT and MRI.
Abdom Radiol (NY). 2018 Oct;43(10):2625-2642. doi: 10.1007/s00261-018-1744-4.
Elsayes KM1, Kielar AZ2, Elmohr MM3, Chernyak V4, Masch WR5, Furlan A6, Marks RM7, Cruite I8, Fowler KJ9, Tang A10, Bashir MR11, Hecht EM12, Kamaya A13, Jambhekar K14, Kamath A15, Arora S16, Bijan B17, Ash R18, Kassam Z19, Chaudhry H20, McGahan JP17, Yacoub JH21, McInnes M22, Fung AW23, Shanbhogue K24, Lee J25, Deshmukh S26, Horvat N27, Mitchell DG26, Do RKG28, Surabhi VR29, Szklaruk J3, Sirlin CB9.
The Liver Imaging and Reporting Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging with the overarching goal of improving communication, clinical care, education, and research relating to patients at risk for or diagnosed with hepatocellular carcinoma (HCC). In 2018, the American Association for the Study of Liver Diseases (AASLD) integrated LI-RADS into its clinical practice guidance for the imaging-based diagnosis of HCC. The harmonization between the AASLD and LI-RADS diagnostic imaging criteria required minor modifications to the recently released LI-RADS v2017 guidelines, necessitating a LI-RADS v2018 update. This article provides an overview of the key changes included in LI-RADS v2018 as well as a look at the LI-RADS v2018 diagnostic algorithm and criteria, technical recommendations, and management suggestions. Substantive changes in LI-RADS v2018 are the removal of the requirement for visibility on antecedent surveillance ultrasound for LI-RADS 5 (LR-5) categorization of 10-19 mm observations with nonrim arterial phase hyper-enhancement and nonperipheral "washout", and adoption of the Organ Procurement and Transplantation Network definition of threshold growth (≥ 50% size increase of a mass in ≤ 6 months). Nomenclatural changes in LI-RADS v2018 are the removal of -us and -g as LR-5 qualifiers.