LI‐RADS (Liver Imaging Reporting and Data System): Summary, discussion, and consensus of the LI‐RADS Management Working Group and future directions

TLDR

LI‑RADS was introduced in 2011 to standardize liver imaging for patients at high risk of hepatocellular carcinoma, defining five categories that classify nodules from benign to definitive HCC. The authors aim to review LI‑RADS, discuss the 2013 Management Working Group consensus, and address its initial discordance with AASLD and OPTN guidelines to improve reporting and consensus among HCC clinicians. The Management Working Group, made up of HCC experts and radiologists, convened to evaluate how LI‑RADS categories influence management decisions and to develop consensus recommendations. Hepatology 2015;61:1056–1065.

Abstract

To improve standardization and consensus regarding performance, interpreting, and reporting computed tomography (CT) and magnetic resonance imaging (MRI) examinations of the liver in patients at risk for hepatocellular carcinoma (HCC), LI‐RADS (Liver Imaging Reporting and Data System) was launched in March 2011 and adopted by many clinical practices throughout the world. LI‐RADS categorizes nodules recognized at CT or MRI, in patients at high risk of HCC, as definitively benign, probably benign, intermediate probability of being HCC, probably HCC, and definitively HCC (corresponding to LI‐RADS categories 1‐5). The LI‐RADS Management Working Group, consisting of internationally recognized medical and surgical experts on HCC management, as well as radiologists involved in the development of LI‐RADS, was convened to evaluate management implications related to radiological categorization of the estimated probability that a lesion will be ultimately diagnosed as HCC. In this commentary, we briefly review LI‐RADS and the initial consensus of the LI‐RADS Management Working Group reached during its deliberations in 2013. We then focus on initial discordance of LI‐RADS with American Association for the Study of Liver Diseases and Organ Procurement Transplant Network guidelines, the basis for these differences, and how they are being addressed going forward to optimize reporting of CT and MRI findings in patients at risk for HCC and to increase consensus throughout the international community of physicians involved in the diagnosis and treatment of HCC. (H epatology 2015;61:1056–1065)