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.
Highlights
MethodsThis systematic review was developed by the LI-RADS Evidence Working Group. The study protocol was not registered
Knowledge gaps.—Despite the importance of nodule diameter, most publications in the radiology literature, even those that have assessed the diagnostic value of diameter, have not described how nodules were measured, leaving the definition of this critical feature ambiguous
LI-RADS has provided a precise definition of diameter and advocates measuring observation diameter on the sequence, phase, and imaging plane in which the margins are most sharply demarcated and in which there is no anatomic distortion
Summary
This systematic review was developed by the LI-RADS Evidence Working Group. The study protocol was not registered. For each LI-RADS major imaging features and imaging features suggesting malignancy other than HCC, the authors reviewed the full-text articles to summarize (a) the biologic basis and rationale, (b) evidence supporting or refuting their continued inclusion, (c) estimates of diagnostic performance or tumor volume doubling time, and (d) knowledge gaps. To address terminology differences and achieve internal consistency, the subgroup members in consensus converted the source terms to their closest LI-RADS equivalents. Another challenge was that source manuscripts used different reference standards. Each subgroup summarized and assessed the quality of the evidence supporting inclusion of its assigned feature or feature set. The GRADE benchmarks and survey results are reported in Appendix E2 (online)
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