LI-RADS: Findings In Pictures
Reena C. Jha
Reena C. Jha, associate professor of radiology and surgery director, MRI, at Georgetown University Hospital in Washington, DC, is coauthor of “LI-RADS Categorization of Benign and Likely Benign Findings in Patients at Risk of Hepatocellular Carcinoma: A Pictorial Atlas,” published in the July 2014 issue of AJR.
Why did you devise the pictorial atlas?
The Liver Imaging Reporting and Data System (LI-RADS) was developed to enable radiologists to assign levels of concern to observations about patients at risk for hepatocellular carcinoma (HCC). The vast majority of observations are, in fact, not malignant and represent a wide variety of other causes, including premalignant nodules and benign entities which may, on occasion, have an altered appearance due to cirrhosis. Sometimes, these observations may simulate malignancy.
How will this article alter the use of LI-RADS in practice?
There are many articles on the imaging of HCC, and the LI-RADS algorithm defines criteria for diagnosis. The purpose of this article is to show imaging features of benign or likely benign entities seen in observations of patients at increased risk of HCC. Each entity is defined, the findings are described, and suggestions for LI-RADS categorization are provided. This should help to reduce the number of observations deemed worrisome for HCC when, in fact, they are likely benign. The pictorial atlas contains numerous images; all can be downloaded to workstations for easy access.
Who benefits from LI-RADS?
Radiologists in private and academic centers, transplant programs (which now require categorization for approval for transplant), gastroenterologists, hepatologists, and researchers. With limited resources for liver transplantation, we want to ensure that when a patient gets a liver transplant for HCC, we are never wrong about the diagnosis. Ultimately, the patient benefits the most.
The article speaks to the need for a standardized lexicon in reporting. How widespread is vocabulary inconsistency?
It is difficult to assess, but is enough of an issue to spur interest in categorization by many institutions. LI-RADS provides a lexicon of precisely defined imaging terms; we created the atlas of illustrative examples to aid radiologists in imaging patients at risk for HCC. The lexicon should improve consistency of practice within and between institutions.
How can that inconsistency affect patients?
Correctly calling an observation benign or likely benign—rather than suspicious or indeterminate for malignancy—has significant implications for management. The former may need no further evaluation than routine surveillance, while the latter may mean that expedited follow-up or an interventional procedure is necessary to establish the diagnosis.
What should a radiologist take away from the article?
Imaging of the cirrhotic liver is difficult! Centers with more extensive experience in liver imaging need to disseminate their experiences to other radiologists in practice. We wanted this article to be a guidepost in recognizing how variants of benign findings can both hide or simulate malignancy.