Wakate Teruya Alexandre Key, Miranda Joao, Leão Filho Hilton, Lahan-Martins Daniel, Tamura Sttefano Guimaraes Cassia, Blasbalg Roberto, Velloni Fernanda Garozzo
DASA, São Paulo, Brazil.
Mayo Clinic, Rochester, United States.
Abdom Radiol (NY). 2025 Aug 27. doi: 10.1007/s00261-025-05110-8.
The Liver Imaging Reporting and Data System (LI-RADS) has become an essential tool for standardizing the detection, diagnosis, and treatment response assessment of hepatocellular carcinoma (HCC) using contrast-enhanced CT and MRI. With the rising incidence of HCC, the use of local-regional therapies (LRT) has also expanded. To address the increasing complexity of post-treatment imaging interpretation, the LI-RADS Treatment Response Assessment (TRA) algorithm was developed to provide a structured and reproducible approach for evaluating tumor response following various forms of LRT. However, imaging features following radiation-based therapies-such as transarterial radioembolization and stereotactic body radiation therapy-often differ from those seen after thermal ablation and transarterial chemoembolization. Recognizing these differences, the 2024 LI-RADS TRA update introduces refinements to improve diagnostic accuracy in this context. This review outlines the evolving role of LI-RADS in post-treatment assessment, highlights imaging findings associated with different LRTs, and explores ongoing refinements aimed at optimizing its clinical utility. Finally, we discuss the need for prospective validation of the new algorithm to confirm its diagnostic performance and clinical impact.
肝脏影像报告和数据系统（LI-RADS）已成为使用对比增强CT和MRI对肝细胞癌（HCC）进行检测、诊断及治疗反应评估标准化的重要工具。随着HCC发病率的上升，局部区域治疗（LRT）的应用也有所扩大。为应对治疗后影像解读日益增加的复杂性，LI-RADS治疗反应评估（TRA）算法得以开发，为评估各种形式LRT后的肿瘤反应提供一种结构化且可重复的方法。然而，基于放射治疗（如经动脉放射性栓塞和立体定向体部放射治疗）后的影像特征通常与热消融和经动脉化疗栓塞后的不同。认识到这些差异，2024年LI-RADS TRA更新引入了改进措施，以提高在此背景下的诊断准确性。本综述概述了LI-RADS在治疗后评估中的不断演变的作用，强调了与不同LRT相关的影像表现，并探讨了旨在优化其临床效用的持续改进。最后，我们讨论了对新算法进行前瞻性验证以确认其诊断性能和临床影响的必要性。
