Imaging after liver-directed therapy: evidenced-based update of the LI-RADS treatment response algorithm

Abstract

There are multiple liver-directed treatment options for hepatocellular carcinoma (HCC), which provide curative intent, help patients achieve remission, and/or provide a bridge to transplant by controlling local tumor progression and downstaging patients. After locoregional therapy (LRT), management of these patients, including liver transplant candidacy, is guided by treatment response assessment. The Liver Imaging Reporting and Data Systems (LI-RADS) treatment response algorithm (TRA) was created to provide a standardized assessment of HCC following LRT. Originally created primarily on expert opinion, subsequent literature has continued to evaluate the validity of this algorithm. In this manuscript, we review emerging literature supporting the use of LI-RADS in the assessment of HCC treatment response after LRT and highlight future updates.

Keywords

Hepatocellular carcinoma / liver imaging data and reporting system treatment response algorithm / loco-regional therapy / treatment response assessment

References

[1] Marrero JA,Sirlin CB.Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the american association for the study of liver diseases.Hepatology2018;68:723-50

[2] American College of Radiology Committee on LI-RADS® (Liver). The LI-RADS® v2018 Manual.Available from: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/LIRADS/LI-RADS-2018-Manual-5Dec18.pdf [Last accessed on 24 May 2023]

[3] Chaudhry M,Mervak B.The LI-RADS version 2018 MRI treatment response algorithm: evaluation of ablated hepatocellular carcinoma.Radiology2020;294:320-6

[4] Shropshire EL,Miller CM.LI-RADS treatment response algorithm: performance and diagnostic accuracy.Radiology2019;292:226-34 PMCID:PMC6614909

[5] Seo N,Park MS.Evaluation of treatment response in hepatocellular carcinoma in the explanted liver with liver imaging reporting and data system version 2017.Eur Radiol2020;30:261-71 PMCID:PMC7485122

[6] Cools KS,Burke LMB.Validation of the liver imaging reporting and data system treatment response criteria after thermal ablation for hepatocellular carcinoma.Liver Transpl2020;26:203-14 PMCID:PMC6980979

[7] Aslam A,Chernyak V.LI-RADS imaging criteria for HCC diagnosis and treatment: emerging evidence.Current Hepatology Reports2020;19:437-47

[8] Goldberg SN,Compton CC,Tanabe KK.Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation.Cancer2000;88:2452-63

[9] Aslam A,Kambadakone A.Hepatocellular carcinoma liver imaging reporting and data systems treatment response assessment: lessons learned and future directions.World J Hepatol2020;12:738-53 PMCID:PMC7643220

[10] Voizard N,Assad A.Assessment of hepatocellular carcinoma treatment response with LI-RADS: a pictorial review.Insights Imaging2019;10:121 PMCID:PMC6920285

[11] Tian G,Yuan J.Comparative efficacy of treatment strategies for hepatocellular carcinoma: systematic review and network meta-analysis.BMJ Open2018;8:e021269 PMCID:PMC6196801

[12] Brook OR,Mendiratta-Lala M.CT imaging findings after stereotactic radiotherapy for liver tumors.Gastroenterol Res Pract2015;2015:126245

[13] Riaz A,Lewandowski RJ.Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres.Hepatology2009;49:1185-93

[14] Zhang Y,Li H.Performance of LI-RADS version 2018 CT treatment response algorithm in tumor response evaluation and survival prediction of patients with single hepatocellular carcinoma after radiofrequency ablation.Ann Transl Med2020;8:388 PMCID:PMC7186681

[15] Ormiston WEL,Lobaugh S.Post-treatment CT LI-RADS categories: predictors of overall survival in hepatocellular carcinoma post bland transarterial embolization.Abdom Radiol2021;46:3738-47 PMCID:PMC7988305

[16] Bartnik K,Rosiak G.Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study.J Cancer Res Clin Oncol2021;147:3673-83 PMCID:PMC8557150

[17] Bartnik K,Rosiak G,Rowiński O.Inter-observer agreement using the LI-RADS version 2018 CT treatment response algorithm in patients with hepatocellular carcinoma treated with conventional transarterial chemoembolization.Abdom Radiol2022;47:115-22 PMCID:PMC8776670

[18] Gupta P,Das GC.Diagnostic accuracy of liver imaging reporting and data system locoregional treatment response criteria: a systematic review and meta-analysis.Eur Radiol2021;31:7725-33

[19] Kierans AS,Dutruel SP.Evaluation of the LI-RADS treatment response algorithm in hepatocellular carcinoma after trans-arterial chemoembolization.Clin Imaging2021;80:117-22

[20] Park S,Lee DH.Diagnostic performance of LI-RADS treatment response algorithm for hepatocellular carcinoma: adding ancillary features to MRI Compared with enhancement patterns at CT and MRI.Radiology2020;296:554-61

[21] Huh YJ,Kim B,Rha SE.Per-feature accuracy of liver imaging reporting and data system locoregional treatment response algorithm: a systematic review and meta-analysis.Cancers2021;13:4432 PMCID:PMC8430492

[22] Jiao Y,Liu H.Radiation-induced cell death and its mechanisms.Health Phys2022;123:376-86 PMCID:PMC9512240

[23] Salem R,Kim E.Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study.Hepatology2021;74:2342-52

[24] Mathew AS,Owen D.Long term outcomes of stereotactic body radiation therapy for hepatocellular carcinoma without macrovascular invasion.Eur J Cancer2020;134:41-51

[25] Schaub SK,Lock MI.Stereotactic body radiation therapy for hepatocellular carcinoma: current trends and controversies.Technol Cancer Res Treat2018;17:1533033818790217 PMCID:PMC6071169

[26] Mastrocostas K,Munoz-Schuffenegger P.Radiological tumor response and histopathological correlation of hepatocellular carcinoma treated with stereotactic body radiation therapy as a bridge to liver transplantation.Abdom Radiol2021;46:1572-85

[27] Reig M,Rimola J.BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update.J Hepatol2022;76:681-93 PMCID:PMC8866082

[28] Mendiratta-Lala M,Owen D.Natural history of hepatocellular carcinoma after stereotactic body radiation therapy.Abdom Radiol2020;45:3698-708

[29] Mendiratta-Lala M,Maturen KE.LI-RADS treatment response algorithm: performance and diagnostic accuracy with radiologic-pathologic explant correlation in patients with SBRT-treated hepatocellular carcinoma.Int J Radiat Oncol Biol Phys2022;112:704-14 PMCID:PMC9400832

[30] Keppke AL,Reddy D.Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres.AJR Am J Roentgenol2007;188:768-75

[31] King MJ,Dane B,Zhan C.Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes.Eur J Radiol2020;133:109351

[32] Vietti Violi N,Law A.Assessment of HCC response to Yttrium-90 radioembolization with gadoxetate disodium MRI: correlation with histopathology.Eur Radiol2022;32:6493-503

[33] Kim SW,Kim HC.LI-RADS treatment response categorization on gadoxetic acid-enhanced MRI: diagnostic performance compared to mRECIST and added value of ancillary features.Eur Radiol2020;30:2861-70

[34] Kim YY,Yoon JK,Roh YH.Incorporation of ancillary mri features into the LI-RADS treatment response algorithm: impact on diagnostic performance after locoregional treatment of hepatocellular carcinoma.AJR Am J Roentgenol2022;218:484-93

[35] Yu JS,Chung JJ.Added value of diffusion-weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas.J Magn Reson Imaging2009;30:153-60

[36] Meloni MF,Livraghi T.Hepatocellular carcinoma treated with radiofrequency ablation: comparison of pulse inversion contrast-enhanced harmonic sonography, contrast-enhanced power Doppler sonography, and helical CT.AJR Am J Roentgenol2001;177:375-80

[37] Choi D,Lee WJ.Early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma: utility of gray scale harmonic ultrasonography with a microbubble contrast agent.J Ultrasound Med2003;22:1163-72

[38] Kim CK,Lim HK.Therapeutic response assessment of percutaneous radiofrequency ablation for hepatocellular carcinoma: utility of contrast-enhanced agent detection imaging.Eur J Radiol2005;56:66-73

[39] Hai Y,Chong W,Lyshchik A.Meta-analysis and systematic review of contrast-enhanced ultrasound in evaluating the treatment response after locoregional therapy of hepatocellular carcinoma.Abdom Radiol2021;46:5162-79 PMCID:PMC8569603

[40] Salvaggio G,Lo Greco V.Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT.Abdom Imaging2010;35:447-53

[41] Liu M,Lu MD.Comparison of contrast-enhanced ultrasound and contrast-enhanced computed tomography in evaluating the treatment response to transcatheter arterial chemoembolization of hepatocellular carcinoma using modified RECIST.Eur Radiol2015;25:2502-11

[42] Pregler B,Wiesinger I.Microwave ablation of large HCC lesions: added value of CEUS examinations for ablation success control.Clin Hemorheol Microcirc2016;64:483-90

[43] Qu P,Liang P.Contrast-enhanced ultrasound in the characterization of hepatocellular carcinomas treated by ablation: comparison with contrast-enhanced magnetic resonance imaging.Ultrasound Med Biol2013;39:1571-9

[44] Dioguardi Burgio M,Libotean C.Lipiodol retention pattern after TACE for HCC is a predictor for local progression in lesions with complete response.Cancer Imaging2019;19:75 PMCID:PMC6858631

[45] Kim DY,Choi JY.Radiological response predicts survival following transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma.Aliment Pharmacol Ther2012;35:1343-50

[46] Letzen BS,Miszczuk M.Lipiodol as an intra-procedural imaging biomarker for liver tumor response to transarterial chemoembolization: post-hoc analysis of a prospective clinical trial.Clin Imaging2021;78:194-200 PMCID:PMC8364875