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ECR 2018 / C-2952
Diagnosing Hepatocellular Carcinoma: A case-based guide to the practical application of Li-RADS 2017 in CT and MRI.
Congress: ECR 2018
Poster No.: C-2952
Type: Educational Exhibit
Keywords: Neoplasia, Multidisciplinary cancer care, Imaging sequences, MR, CT, Oncology, Liver, Abdomen
Authors: J. Bell, C. R. Smith, C. G. D. Clarke, R. Albazaz, A. Guthrie, E. Tjio, J. Wyatt, M. Sheridan; Leeds/UK




Liver cancer represents a major health burden, it is the fifth commonest cancer in men and the ninth commonest in women and represents the second most common cause of death from cancer worldwide with an estimated 746,000 deaths in 20121


HCC represents the commonest primary liver malignancy. The commonest risk factor for HCC is cirrhosis, regardless of the underlying cause.  


HCC in the cirrhotic liver has specific imaging characteristics and increasingly treatment is planned based on non-invasive criteria using MRI and CT characteristics.


While free text reports and clinico-radiological discussion forms the basis of most radiologist's work, we know that non-structured reporting can lead to inconsistencies in the description and interpretation of lesions as well as making large scale analysis of outcomes difficult.


The use of structured radiology reporting systems has been shown to improve communication of findings and allows these findings to be presented in a clear and repeatable fashion.


What is LI-RADS?


the Liver Imaging Reporting And Data System is a categorisation system developed to try and standardise both reporting and data collection for findings in patients at high risk of liver cancer. LI-RADS has been produced by the American College of Radiology who's stated aims are to allow radiologists to2:


  • Apply consistent terminology
  • Reduce imaging interpretation variability and errors
  • Enhance communication with referring clinicians
  • Facilitate quality assurance and research

LI-RADS was first introduced in 2014, an update to the guidelines has been published in 2017. Key changes include the introduction of two new algorithms, one for surveillance ultrasound and one for characterisation using contrast enhanced ultrasound. Additionally, there have been some changes to some of the CT/MRI criteria as well as the nomenclature. These will be highlighted in the subsequent section. 



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