Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, with rising clinical and economic burden as incidence increases. There are a multitude of evolving treatment options, including locoregional therapies which can be used alone, in combination with each other, or in combination with systemic therapy. These treatment options have shown to be effective in achieving remission, controlling tumor progression, improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients. Following locoregional therapy (LRT), it is crucial to provide treatment response assessment to guide management and liver transplant candidacy. Therefore, Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of HCC following LRT. LI-RADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment. In this review, we provide an overview of different locoregional therapies for HCC, describe the expected post treatment imaging appearance following treatment, and review the LI-RADS TRA with guidance for its application in clinical practice. Unique to other publications, we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.

Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study

“…The LR-TR was primarily designed to increase inter-reader agreement in reporting and improve decision-making processes (Voizard et al 2019a ). It is a relatively new algorithm that offers new opportunities to further improve HCC patient care, but still requires in-depth research (Aslam et al 2020b ; Do and Mendiratta-Lala 2020 ). Previous studies have shown that tumor response after TACE (assessed using the mRECIST or WHO criteria) is associated with patient outcomes/overall survival (Shim et al 2012 ).…”

Assessment of response to liver directed radiation-based therapies: Current guidelines, challenges, and future directions

“…After treatment, it is important to assess tumor response to determine further management, patient prognosis, and endpoint outcomes for clinical trials. Histopathologic changes within the post-radiation treatment bed are well characterized [26,27] , although histologic assessment of response with follow-up biopsy in clinical practice is not feasible. Imaging, aided or not by clinical and laboratory data (e.g., Alphafetoprotein levels), is the most used method to assess changes in tumor burden as a predictor of treatment response.…”

Abbreviated MRI Protocol for the Assessment of Ablated Area in HCC Patients

“…Additionally, Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) has been conceived to offer a standardized evaluation of HCC following loco regional therapy (LRT). LI-RADS TRA offers a step-by-step method to assess each nodule individually for precise treatment evaluation [ 20 ]. Although the adoption of imaging tool (computed tomography (CT) or magnetic resonance imaging (MRI)) can be subject to patient characteristics and institutional inclination, it is critical to maintain consistency in the imaging performed before and after treatment.…”

“…Although the adoption of imaging tool (computed tomography (CT) or magnetic resonance imaging (MRI)) can be subject to patient characteristics and institutional inclination, it is critical to maintain consistency in the imaging performed before and after treatment. Precise assessment of post-treatment imaging is critical to guide further management decisions and requires comparison of post- treatment with pre-treatment imaging to recognize the original lesion diameter and enhancement features [ 20 ]. Follow-up imaging of patients with treated HCC is performed to evaluate for new lesions, monitor for evidence of early recurrence and observe for neovascularity that may allow for detection of pathological angiogenesis within the ablation zone.…”