CT/MRI LI-RADS 2024 Update: Treatment Response Assessment
Anum Aslam, Victoria Chernyak, Frank H. Miller, Mustafa R. Bashir, Richard Kinh Gian, Claude B. Sirlin, Robert J. Lewandowski, Charles Kim, Ania Z. Kielar, Avinash Kambadakone, Hooman Yarmohammadi, Edward Kim, Dawn Owen, Resmi A. Charalel, Anuradha S. Shenoy‐Bhangle, Lauren M. Burke, Mishal Mendiratta‐Lala
Abstract
With the rising incidence of hepatocellular carcinoma, there has been increasing use of local-regional therapy (LRT) to downstage or bridge to transplant, for definitive treatment, and for palliation. The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Assessment (TRA) algorithm provides guidance for step-by-step tumor assessment after LRT and standardized reporting. Current evidence suggests that the algorithm performs well in the assessment of tumor response to arterial embolic and loco-ablative therapies and fair when assessing response to radiation-based therapies, with limited data to validate the latter. Both evidence-based and expert-based refinements of the algorithm are needed to improve its diagnostic accuracy after varying types of LRT. This review provides an overview of the challenges and limitations of the LI-RADS TRA algorithm version 2017 and discusses the refinements introduced in the updated 2024 LI-RADS algorithm for CT/MRI.