From the Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.); Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY (V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center, Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical Center, Durham, NC (M.B.); Department of Radiology, University of California San Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.).
Radiology. 2024 Nov;313(2):e232408. doi: 10.1148/radiol.232408.
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.
随着肝细胞癌发病率的上升，越来越多地使用局部区域治疗（LRT）进行降期或桥接移植、确定性治疗和姑息治疗。CT/MRI 肝脏成像报告和数据系统（LI-RADS）治疗反应评估（TRA）算法为 LRT 后肿瘤逐步评估和标准化报告提供了指导。目前的证据表明，该算法在评估动脉栓塞和局部消融治疗的肿瘤反应方面表现良好，在评估基于放射的治疗反应方面表现尚可，后者的验证数据有限。需要对该算法进行基于证据和专家的改进，以提高其在不同类型 LRT 后的诊断准确性。本文综述了 LI-RADS TRA 算法 2017 版的挑战和局限性，并讨论了在更新的 2024 版 LI-RADS 算法中为 CT/MRI 引入的改进。
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