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World J Gastroenterol. Aug 28, 2022; 28(32): 4540-4556
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4540
Liver Imaging Reporting and Data System criteria for the diagnosis of hepatocellular carcinoma in clinical practice: A pictorial minireview
Christina Liava, Emmanouil Sinakos, Elissavet Papadopoulou, Lamprini Giannakopoulou, Stamatia Potsi, Anestis Moumtzouoglou, Anthi Chatziioannou, Loukas Stergioulas, Lydia Kalogeropoulou, Ioannis Dedes, Evangelos Akriviadis, Danai Chourmouzi
Christina Liava, Emmanouil Sinakos, Anthi Chatziioannou, Evangelos Akriviadis, 4th Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Elissavet Papadopoulou, Lamprini Giannakopoulou, Stamatia Potsi, Anestis Moumtzouoglou, Loukas Stergioulas, Lydia Kalogeropoulou, Ioannis Dedes, Danai Chourmouzi, Department of Radiology, Interbalkan Medical Center, Thessaloniki 57001, Greece
Author contributions: Liava C, Sinakos E, Danai C, Chatziioannou A, and Akriviadis E drafted the article; Papadopoulou E, Giannakopoulou L, Potsi S, Moumtzouoglou A, Stergioulas L, Kalogeropoulou L, Dedes I, and Chourmouzi D provided the computed tomography and magnetic resonance imaging images and drafted the figure legends; Sinakos E made critical revisions related to important intellectual content and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emmanouil Sinakos, MD, PhD, Associate Professor, 4th Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki 54642, Greece. em_sinakos@yahoo.com
Received: January 31, 2022
Peer-review started: January 31, 2022
First decision: February 24, 2022
Revised: March 10, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: August 28, 2022
Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer. The main risk factors associated with HCC development include hepatitis B virus, hepatitis C virus, alcohol consumption, aflatoxin B1, and nonalcoholic fatty liver disease. However, hepatocarcinogenesis is a complex multistep process. Various factors lead to hepatocyte malignant transformation and HCC development. Diagnosis and surveillance of HCC can be made with the use of liver ultrasound (US) every 6 mo. However, the sensitivity of this imaging method to detect HCC in a cirrhotic liver is limited, due to the abnormal liver parenchyma. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered to be most useful tools for at-risk patients or patients with inadequate US. Liver biopsy is still used for diagnosis and prognosis of HCC in specific nodules that cannot be definitely characterized as HCC by imaging. Recently the American College of Radiology designed the Liver Imaging Reporting and Data System (LI-RADS), which is a comprehensive system for standardized interpretation of CT and MRI liver examinations that was first proposed in 2011. In 2018, it was integrated into the American Association for the Study of Liver Diseases guidance statement for HCC. LI-RADS is designed to ensure high sensitivity, precise categorization, and high positive predictive value for the diagnosis of HCC and is applied to “high-risk populations” according to specific criteria. Most importantly LI-RADS criteria achieved international collaboration and consensus among liver experts around the world on the best practices for caring for patients with or at risk for HCC.

Keywords: Hepatocellular carcinoma, Hepatocarcinogenesis, Computed tomography, Magnetic resonance imaging, Liver Imaging Reporting and Data System

Core Tip: Worldwide, hepatocellular carcinoma (HCC) is the sixth most common malignancy and fourth cause of cancer-related death. Progress on the diagnosis and treatment possibilities of HCC has been made over the past decades. We herein review the available knowledge on the carcinogenesis, surveillance of HCC, and relevant data with the Liver Imaging Reporting and Data System (LI-RADS) algorithm that was recently integrated into the American Association for the Study of Liver Diseases clinical practice guidelines. LI-RADS aims to avoid false-positive examinations and ensure high sensitivity and positive predictive value in high-risk populations with simultaneous achievement of probabilistic categorization of the tumor.