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Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions
Authors:Anum Aslam  Richard Kinh Gian Do  Avinash Kambadakone  Bradley Spieler  Frank H Miller  Ahmed M Gabr  Resmi A Charalel  Charles Y Kim  David C Madoff  Mishal Mendiratta-Lala
Abstract:Hepatocellular carcinoma(HCC) is a leading cause of morbidity and mortality worldwide, with rising clinical and economic burden as incidence increases. Thereare 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. LIRADS 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.
Keywords:Hepatocellular carcinoma   Liver Imaging Reporting and Data Systems Treatment Response Algorithm   Locoregional therapy   Liver Imaging Reporting and Data Systems Treatment Response equivocal   Arterial phase hyper enhancement   Stereotactic body radiotherapy
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