Pitfalls and problems to be solved in the diagnostic CT/MRI Liver Imaging Reporting and Data System (LI-RADS)
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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.
• 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.
KeywordsAlgorithms Diagnosis Liver cancer Tomography Magnetic resonance imaging
Arterial phase hyperenhancement
Extracellular contrast agent
Liver Imaging Reporting and Data System
Portal venous phase
The authors state that this work has not received any funding.
Compliance with ethical standards:
The scientific guarantor of this publication is Jin-Young Choi in Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was not required because this review article does not include analysis of patient data.
Institutional Review Board approval was not required because this review article does not include analysis of patient data.
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