Evaluation of treatment response in hepatocellular carcinoma in the explanted liver with Liver Imaging Reporting and Data System version 2017

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To investigate the performance of Liver Imaging Reporting and Data System (LI-RADS) v2017 treatment response algorithm for predicting hepatocellular carcinoma (HCC) viability after locoregional therapy (LRT) using the liver explant as reference.


One hundred fourteen patients with 206 HCCs who underwent liver transplantation (LT) after LRT for HCCs were included in this retrospective study. Two radiologists independently evaluated tumor viability using the LI-RADS and modified RECIST (mRECIST) with CT and MRI, respectively. The sensitivity and specificity of arterial phase hyperenhancement (APHE) and LR-TR viable criteria (any of three findings: APHE, washout, and enhancement pattern similar to pretreatment imaging) were compared using logistic regression. Receiver operating characteristics (ROC) analysis was used to compare the diagnostic performance between LI-RADS and mRECIST and between CT and MRI.


The sensitivity and specificity for diagnosing viable tumor were not significantly different between APHE alone and LR-TR viable criteria on CT (p = 0.054 and p = 0.317) and MRI (p = 0.093 and p = 0.603). On CT, the area under the ROC curve (AUC) of LI-RADS was significantly higher than that of mRECIST (0.733 vs. 0.657, p < 0.001). On MRI, there was no significant difference in AUCs between LI-RADS and mRECIST (0.802 vs. 0.791, p = 0.500). Intra-individual comparison of CT and MRI showed comparable AUCs using LI-RADS (0.783 vs. 0.795, p = 0.776).


LI-RADS v2017 treatment response algorithm showed better diagnostic performance than mRECIST on CT. With LI-RADS, CT and MRI were comparable to diagnose tumor viability of HCC after LRT.

Key Points

Using Liver Imaging Reporting and Data System (LI-RADS) v2017 treatment response algorithm, the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) can be accurately diagnosed.

LI-RADS v2017 treatment response algorithm is superior to modified Response Evaluation Criteria in Solid Tumors for evaluating HCC viability using CT.

Either CT or MRI can be performed to assess tumor viability after LRT using LI-RADS v2017 treatment response algorithm.

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Change history

  • 23 November 2020

    The original version of this article, published on 15 August 2019, unfortunately contained a mistake.



Arterial phase hyperenhancement


Computed tomography


European Association for the Study of the Liver


Generalized estimating equation


Hepatocellular carcinoma


Liver Imaging Reporting and Data System


Locoregional therapy


Liver transplantation


Modified Response Criteria in Solid Tumors


Magnetic resonance imaging


Picture archiving and communication system


Radiofrequency ablation


Transarterial chemoembolization


World Health Organization


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Correspondence to Mi-Suk Park.

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The scientific guarantor of this publication is Mi-Suk Park.

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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

Kyunghwa Han performed statistical analysis, who is one of the coauthors.

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Written informed consent was waived by the Institutional Review Board.

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Seo, N., Kim, M.S., Park, MS. et al. Evaluation of treatment response in hepatocellular carcinoma in the explanted liver with Liver Imaging Reporting and Data System version 2017. Eur Radiol 30, 261–271 (2020). https://doi.org/10.1007/s00330-019-06376-5

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  • Liver transplantation
  • Hepatocellular carcinoma
  • Multidetector computed tomography
  • Magnetic resonance imaging
  • Therapeutic chemoembolization