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      Up-to-Date Role of CT/MRI LI-RADS in Hepatocellular Carcinoma

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          Abstract

          Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide and a major healthcare burden in most societies. Computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the medical care of patients with or at risk for hepatocellular carcinoma (HCC). When stringent imaging criteria are fulfilled, CT and MRI allow for diagnosis, staging, and assessment of response to treatment, without the need for invasive workup, and can inform clinical decision making. Owing to the central role of these imaging modalities in HCC management, standardization is essential to facilitate proper imaging technique, accurate interpretation, and clear communication among all stakeholders in both the clinical practice and research settings. The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system that provides standardization across the continuum of HCC imaging, including ordinal probabilistic approach for reporting that directs individualized management. This review discusses the up-to-date role of CT and MRI in HCC imaging from the LI-RADS perspective. It also provides a glimpse into the future by discussing how advances in knowledge and technology are likely to enrich the LI-RADS approach.

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          Most cited references67

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          Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases

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            A comparison of deep learning performance against health-care professionals in detecting diseases from medical imaging: a systematic review and meta-analysis

            Deep learning offers considerable promise for medical diagnostics. We aimed to evaluate the diagnostic accuracy of deep learning algorithms versus health-care professionals in classifying diseases using medical imaging.
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              Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis

              Background & Aims Society guidelines differ in their recommendations for surveillance to detect early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis. We compared the performance of surveillance imaging, with or without alpha fetoprotein (AFP), for early detection of HCC in patients with cirrhosis Methods Two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Results Thirty-two studies (comprising 13367 patients) characterized sensitivity of imaging with or without AFP measurement for detection of HCC in patients with cirrhosis. Ultrasound detected any stage HCC with 84% sensitivity (95% CI, 76%–92%), but early-stage HCC with only 47% sensitivity (95% CI, 33%–61%). In studies comparing ultrasound with vs without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR], 0.88; 95% CI, 0.83–0.93) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR, 0.81; 95% CI, 0.71–0.93). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR, 1.08; 95% CI, 1.05–1.09). Ultrasound with vs without AFP detected early-stage HCC with 63% sensitivity (95% CI, 48%–75%) and 45% sensitivity (95% CI, 30%–62%), respectively ( P =.002). Only 4 studies evaluated computed tomography or magnetic resonance image-based surveillance, which detected HCC with 84% sensitivity (95% CI, 70%–92%). Conclusions In a meta-analysis of publications, we found ultrasound alone to detect early-stage HCC with a low level of sensitivity in patients with cirrhosis. Addition of AFP to ultrasound analysis significantly increases the sensitivity of HCC detection in clinical practice.
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                Author and article information

                Journal
                J Hepatocell Carcinoma
                J Hepatocell Carcinoma
                jhc
                jhepc
                Journal of Hepatocellular Carcinoma
                Dove
                2253-5969
                31 May 2021
                2021
                : 8
                : 513-527
                Affiliations
                [1 ]Liver Imaging Group, Department of Radiology, University of California San Diego , La Jolla, CA, USA
                [2 ]Department of Radiology, Beth Israel Deaconess Medical Center , Boston, MA, USA
                Author notes
                Correspondence: Guilherme Moura Cunha Liver Imaging Group, Department of Radiology, University of California San Diego , 9500 Gilman Dr. Mail Code 0888, La Jolla, San Diego, CA, 92093, USA Email gcunha@uw.edu
                Author information
                http://orcid.org/0000-0001-6403-5155
                http://orcid.org/0000-0002-6639-9072
                Article
                268288
                10.2147/JHC.S268288
                8180267
                34104640
                e74d9b90-15f1-46d8-a11b-8fc944ebf2e1
                © 2021 Moura Cunha et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 28 January 2021
                : 01 April 2021
                Page count
                Figures: 5, Tables: 5, References: 73, Pages: 15
                Categories
                Review

                hepatocellular carcinoma,computed tomography,magnetic resonance imaging,li-rads

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