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Pitfalls and problems to be solved in the diagnostic CT/MRI Liver Imaging Reporting and Data System (LI-RADS)

 Yeun-Yoon Kim  ;  Jin-Young Choi  ;  Claude B. Sirlin  ;  Chansik An  ;  Myeong-Jin Kim 
 EUROPEAN RADIOLOGY, Vol.29(3) : 1124-1132, 2019 
Journal Title
Issue Date
Algorithms* ; Carcinoma, Hepatocellular/diagnosis* ; Data Systems* ; Humans ; Liver Neoplasms/diagnosis* ; Magnetic Resonance Imaging/methods* ; Research Design/statistics & numerical data* ; Tomography, X-Ray Computed/methods*
Algorithms ; Diagnosis ; Liver cancer ; Magnetic resonance imaging ; Tomography
The 2017 Core of the computed tomography (CT)/magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) provides clear definitions and concise explanations of the CT/MRI diagnostic algorithm. Nevertheless, there remain some practical and controversial issues that radiologists should be aware of when using the system. This article discusses pitfalls and problems which may be encountered when the version 2017 diagnostic algorithm is used for CT and MRI. The pitfalls include challenges in applying major features and assigning the LR-M category, as well as categorisation discrepancy between CT and MRI. The problems include imprecision of category codes, application of ancillary features, and regional practice variations in hepatocellular carcinoma (HCC) diagnosis. Potential solutions are presented along with these pitfalls and problems. KEY POINTS: • Although the diagnostic algorithm provides clear and detailed explanations, major feature evaluation can be subject to pitfalls and differentiation of HCC and non-HCC malignancy remains challenging. • Ancillary features are optional and equally weighted. However, features such as hepatobiliary phase hypointensity and restricted diffusion have greater impact on HCC diagnosis than other ancillary features and may merit greater emphasis or weighting. • LI-RADS was initially developed from a Western paradigm, which may limit its applicability in the East due to regional practice variations. In Eastern Asia, high sensitivity is prioritised over near-perfect specificity for HCC diagnosis in order to detect tumours at early stages.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Yeun-Yoon(김연윤) ORCID logo https://orcid.org/0000-0003-2018-5332
An, Chansik(안찬식) ORCID logo https://orcid.org/0000-0002-0484-6658
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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