Aslam Anum, Do Richard Kinh Gian, Kambadakone Avinash, Spieler Bradley, Miller Frank H, Gabr Ahmed M, Charalel Resmi A, Kim Charles Y, Madoff David C, Mendiratta-Lala Mishal
Department of Radiology, University of Michigan, Ann Arbor, MI 48019, United States.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
World J Hepatol. 2020 Oct 27;12(10):738-753. doi: 10.4254/wjh.v12.i10.738.
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.
肝细胞癌（HCC）是全球发病和死亡的主要原因，随着发病率的增加，临床和经济负担也在不断上升。目前有多种不断发展的治疗选择，包括局部区域治疗，这些治疗可单独使用、相互联合或与全身治疗联合使用。这些治疗方案已被证明在实现缓解、控制肿瘤进展、改善无法接受手术切除患者的无病生存期和总生存期以及通过减轻肿瘤负荷使患者降期从而为移植提供桥梁方面是有效的。在进行局部区域治疗（LRT）后，提供治疗反应评估以指导管理和肝移植候选资格至关重要。因此，创建了肝脏影像报告和数据系统（LI-RADS）治疗反应算法（TRA），以对LRT后的HCC进行标准化评估。LI-RADS TRA提供了一种逐步方法，可独立评估每个病灶以进行准确的肿瘤评估。在本综述中，我们概述了HCC的不同局部区域治疗方法，描述了治疗后预期的影像学表现，并回顾了LI-RADS TRA及其在临床实践中的应用指南。与其他出版物不同的是，我们还将回顾支持使用LI-RADS评估LRT后HCC治疗反应的新文献。
