Skip to main content
SpringerLink
Log in

LI-RADS and transplantation: challenges and controversies

  • Special Section: Liver Transplantation
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Patients with early stage hepatocellular carcinoma (HCC) can be cured by liver transplantation. HCC imaging features on CT or MRI are specific enough to allow for definitive diagnosis and treatment without the need of confirmatory biopsy. When applied to the appropriate at-risk population the Liver Imaging Reporting and Data System (LI-RADS) imaging criteria achieve high specificity and positive predictive value for the diagnosis of HCC. The Organ Procurement and Transplantation Network (OPTN) is the United States organization that aims to assure the adequate and fair distribution of livers across candidates. Given the importance of fair organ allocation, OPTN also provides stringent imaging criteria for the diagnosis of HCC aiming to avoid false positive diagnosis. Although most imaging criteria are identical for both systems, discrepancies between LI-RADS and the current OPTN classification system for HCC diagnosis exists. Main differences include, but are not limited to, the binary approach of OPTN to classify lesions as HCC or not, versus the probabilistic algorithmic approach of LI-RADS, technical and interpretation considerations, and the approach towards treated lesions. The purpose of this article is to highlight the similarities and discrepancies between LI-RADS and the current OPTN criteria for HCC diagnosis and the implications that these differences may have on the management of patients who are transplant candidates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

[adapted from (17) Elsayes KM, Kielar AZ, Chernyak V, Morshid A, Furlan A, Masch WR, et al. LI-RADS: a conceptual and historical review from its beginning to its recent integration into AASLD clinical practice guidance. J Hepatocell Carcinoma. 2019 Feb 5;6:49–69]

Fig. 3
Fig. 4

[adapted from (66) Kielar A, Fowler KJ, Lewis S, Yaghmai V, Miller FH, Yarmohammadi H, et al. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY). 2018 Jan;43(1):218–230]

Similar content being viewed by others

Abbreviations

HCC:

Hepatocellular Carcinoma

LT:

Liver transplantation

UNOS:

United Network for Organ Sharing

OPTN:

Organ Procurement and Transplantation Network

MELD:

Model for End-Stage Liver Disease

LI-RADS:

Liver Imaging Reporting and Data System

References

  1. Hester CA, Rich NE, Singal AG, Yopp AC. Comparative Analysis of Nonalcoholic Steatohepatitis–Versus Viral Hepatitis–and Alcohol-Related Liver Disease–Related Hepatocellular Carcinoma. J Natl Compr Canc Netw. 2019 Apr 1;17(4):322-329. https://doi.org/10.6004/jnccn.2018.7105.

    Article  CAS  PubMed  Google Scholar 

  2. Seo N, Kim MS, Park MS, Choi JY, An C, Han K et al. Optimal criteria for hepatocellular carcinoma diagnosis using CT in patients undergoing liver transplantation. Eur Radiol. 2019 Feb;29(2):1022-1031. https://doi.org/10.1007/s00330-018-5557-1.

    Article  PubMed  Google Scholar 

  3. Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, Mariani L. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence‐based analysis of 15 years of experience. Liver Transpl. 2011 Oct;17 Suppl 2:S44-57. https://doi.org/10.1002/lt.22365.

    Article  PubMed  Google Scholar 

  4. Tang A, Fowler KJ, Chernyak V, Chapman WC, Sirlin CB. LI-RADS and transplantation for hepatocellular carcinoma. Abdom Radiol (NY). 2018 Jan;43(1):193-202. https://doi.org/10.1007/s00261-017-1210-8.

    Article  PubMed  Google Scholar 

  5. Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology. 2013 Feb;266(2):376-82. https://doi.org/10.1148/radiol.12121698.

    Article  PubMed  Google Scholar 

  6. Organ Procurement and Transplant Network (OPTN) Policies: effective 8/15/2019 https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf [accessed on 9/01/2019]

  7. Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ, Roberts LR, Heimbach JA, Leise MD. Hepatocellular carcinoma is the most common indication for liver transplantation and placement on the waitlist in the United States. Clin Gastroenterol Hepatol. 2017 May;15(5):767-775.e3. https://doi.org/10.1016/j.cgh.2016.11.034.

    Article  PubMed  Google Scholar 

  8. Goldberg DS, Olthoff KM. Standardizing MELD exceptions: current challenges and future directions. Curr Transplant Rep. 2014 Dec 1;1(4):232-237.

    Article  Google Scholar 

  9. Kamath A, Roudenko A, Hecht E, Sirlin C, Chernyak V, Fowler K, Mitchell DG. CT/MR LI-RADS 2018: clinical implications and management recommendations. Abdom Radiol (NY). 2019 Apr;44(4):1306-1322. https://doi.org/10.1007/s00261-018-1868-6.

    Article  PubMed  Google Scholar 

  10. Younossi Z, Stepanova M, Ong JP, Jacobson IM, Bugianesi E, Duseja A et al. Nonalcoholic steatohepatitis is the fastest growing cause of hepatocellular carcinoma in liver transplant candidates. Clin Gastroenterol Hepatol. 2019 Mar;17(4):748-755.e3. https://doi.org/10.1016/j.cgh.2018.05.057.

    Article  PubMed  Google Scholar 

  11. Compagnon P, Grandadam S, Lorho R, Turlin B, Camus C, Jianrong Y, Lainé F, Meunier B, Deugnier Y, Boudjema K. Liver transplantation for hepatocellular carcinoma without preoperative tumor biopsy. Transplantation. 2008 Oct 27;86(8):1068-76. https://doi.org/10.1097/tp.0b013e318187754c.

    Article  PubMed  Google Scholar 

  12. Hayashi PH, Trotter JF, Forman L, Kugelmas M, Steinberg T, Russ P, Wachs M, Bak T, Kam I, Everson GT. Impact of pretransplant diagnosis of hepatocellular carcinoma on cadveric liver allocation in the era of MELD. Liver Transpl. 2004 Jan;10(1):42-8.

    Article  Google Scholar 

  13. Freeman Jr RB, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, Merion R, Wolfe R, Turcotte J, Teperman L. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002 Sep;8(9):851-8.

    Article  Google Scholar 

  14. Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy. Gastroenterology. 2004 Nov;127(5 Suppl 1):S261-7.

    Article  Google Scholar 

  15. Pomfret EA, Sung RS, Allan J, Kinkhabwala M, Melancon JK, Roberts JP. Solving the organ shortage crisis: the 7th annual American Society of Transplant Surgeons’ State‐of‐the‐Art Winter Symposium. Am J Transplant. 2008 Apr;8(4):745-52. https://doi.org/10.1111/j.1600-6143.2007.02146.x.

    Article  CAS  PubMed  Google Scholar 

  16. Pomfret EA, Washburn K, Wald C, Nalesnik MA, Douglas D, Russo M, Roberts J, Reich DJ, Schwartz ME, Mieles L, Lee FT. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl. 2010 Mar;16(3):262-78. https://doi.org/10.1002/lt.21999.

    Article  PubMed  Google Scholar 

  17. Elsayes KM, Kielar AZ, Chernyak V, Morshid A, Furlan A, Masch WR, et al. LI-RADS: a conceptual and historical review from its beginning to its recent integration into AASLD clinical practice guidance. J Hepatocell Carcinoma. 2019 Feb 5;6:49-69. https://doi.org/10.2147/jhc.s186239.

    Article  Google Scholar 

  18. Clark T, Maximin S, Meier J, Pokharel S, Bhargava P. Hepatocellular carcinoma: review of epidemiology, screening, imaging diagnosis, response assessment, and treatment. Curr Probl Diagn Radiol. 2015 Nov-Dec;44(6):479-86. https://doi.org/10.1067/j.cpradiol.2015.04.004.

  19. Yacoub JH, Miller FH. Understanding LI-RADS, its relationship to AASLD and OPTN, and the challenges of its adoption. Curr Hepatol Rep. 2017 Mar 1;16(1):72-80.

    Article  Google Scholar 

  20. Chernyak V, Flusberg M, Berman J, Fruitman KC, Kobi M, Fowler KJ, Sirlin CB. Liver Imaging Reporting and Data System (LI‐RADS) v2018: Impact on Categorization and Hepatocellular Carcinoma Staging. Liver Transpl. 2019 Jul 25. https://doi.org/10.1002/lt.25614. [Epub ahead of print]

  21. Ren AH, Zhao PF, Yang DW, Du JB, Wang ZC, Yang ZH. Diagnostic performance of MR for hepatocellular carcinoma based on LI‐RADS v2018, compared with v2017. J Magn Reson Imaging. 2019 Sep;50(3):746-755. https://doi.org/10.1002/jmri.26640.

    Article  PubMed  Google Scholar 

  22. Lee SM, Lee JM, Ahn SJ, Kang HJ, Yang HK, Yoon JH. LI-RADS Version 2017 versus Version 2018: Diagnosis of Hepatocellular Carcinoma on Gadoxetate Disodium–enhanced MRI. Radiology. 2019 Sep;292(3):655-663. https://doi.org/10.1148/radiol.2019182867.

    Article  PubMed  Google Scholar 

  23. van der Pol CB, Lim CS, Sirlin CB, McGrath TA, Salameh JP, Bashir MR, Tang A, Singal AG, Costa AF, Fowler K, McInnes MD. Accuracy of the liver imaging reporting and data system in computed tomography and magnetic resonance image analysis of hepatocellular carcinoma or overall malignancy—a systematic review. Gastroenterology. 2019 Mar;156(4):976-986. https://doi.org/10.1053/j.gastro.2018.11.020.

    Article  PubMed  Google Scholar 

  24. Lunsford KE, Court C, Seok Lee Y, Lu DS, Naini BV, Harlander‐Locke MP, Busuttil RW, Agopian VG. Propensity‐Matched Analysis of Patients with Mixed Hepatocellular‐Cholangiocarcinoma and Hepatocellular Carcinoma Undergoing Liver Transplantation. Liver Transpl. 2018 Oct;24(10):1384-1397. https://doi.org/10.1002/lt.25058.

    Article  PubMed  Google Scholar 

  25. Jeon SK, Joo I, Lee DH, Lee SM, Kang HJ, Lee KB, Lee JM. Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging. Eur Radiol. 2019 Jan;29(1):373-382. https://doi.org/10.1007/s00330-018-5605-x.

    Article  PubMed  Google Scholar 

  26. Choi SH, Lee SS, Park SH, Kim KM, Yu E, Park Y, Shin YM, Lee MG. LI-RADS classification and prognosis of primary liver cancers at gadoxetic acid–enhanced MRI. Radiology. 2019 Feb;290(2):388-397. https://doi.org/10.1148/radiol.2018181290.

    Article  PubMed  Google Scholar 

  27. An C, Park S, Chung YE, Kim DY, Kim SS, Kim MJ, Choi JY. Curative resection of single primary hepatic malignancy: Liver Imaging Reporting and Data System category LR-M portends a worse prognosis. AJR Am J Roentgenol. 2017 Sep;209(3):576-583. https://doi.org/10.2214/ajr.16.17478.

    Article  PubMed  Google Scholar 

  28. Piscaglia F, Gianstefani A, Ravaioli M, Golfieri R, Cappelli A, Giampalma E, et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transpl. 2010 May;16(5):658-67. https://doi.org/10.1002/lt.22044.

    Article  PubMed  Google Scholar 

  29. Jeong Y, Shin MH, Yoon SM, Song GW, Kim KH, Ahn CS, Moon DB, Hwang S, Park JH, Kim JH, Lee SG. Liver transplantation after transarterial chemoembolization and radiotherapy for hepatocellular carcinoma with vascular invasion. Journal of Gastrointestinal Surgery. 2017 Feb 1;21(2):275-83. J Gastrointest Surg. 2017 Feb;21(2):275-283. https://doi.org/10.1007/s11605-016-3302-0.

  30. Lee KW, Suh SW, Choi Y, Jeong J, Yi NJ, Kim H, Yoon KC, Hong SK, Kim HS, Lee KB, Suh KS. Macrovascular invasion is not an absolute contraindication for living donor liver transplantation. Liver Transpl. 2017 Jan;23(1):19-27. https://doi.org/10.1002/lt.24610.

    Article  PubMed  Google Scholar 

  31. Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology. 2010 Jan;254(1):154-62. https://doi.org/10.1148/radiol.09090304.

    Article  PubMed  Google Scholar 

  32. Sandrasegaran K, Tahir B, Nutakki K, Akisik FM, Bodanapally U, Tann M, Chalasani N. Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. AJR Am J Roentgenol. 2013 Dec;201(6):1211-9. https://doi.org/10.2214/ajr.12.10171.

    Article  PubMed  Google Scholar 

  33. Kim JH, Lee JM, Yoon JH, Lee DH, Lee KB, Han JK, Choi BI. Portal vein thrombosis in patients with hepatocellular carcinoma: diagnostic accuracy of gadoxetic acid–enhanced MR imaging. Radiology. 2016 Jun;279(3):773-83. https://doi.org/10.1148/radiol.2015150124.

    Article  PubMed  Google Scholar 

  34. Gawande R, Jalaeian H, Niendorf E, Olgun D, Krystosek L, Rubin N, Spilseth B. MRI in differentiating malignant versus benign portal vein thrombosis in patients with hepatocellular carcinoma: Value of post contrast imaging with subtraction. Eur J Radiol. 2019 Sep;118:88-95. https://doi.org/10.1016/j.ejrad.2019.07.008.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chammas MC, Oliveira AC, Moraes PH, Takahashi MS. Characterization of Malignant Portal Vein Thrombosis with Contrast-Enhanced Ultrasonography. Ultrasound Med Biol. 2019 Jan;45(1):50-55. https://doi.org/10.1016/j.ultrasmedbio.2018.09.009.

    Article  PubMed  Google Scholar 

  36. Rossi S, Ghittoni G, Ravetta V, Viera FT, Rosa L, Serassi M, et al. Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol. 2008 Aug;18(8):1749-56. https://doi.org/10.1007/s00330-008-0931-z.

    Article  PubMed  Google Scholar 

  37. Ayuso C, Rimola J, Vilana R, Burrel M, Darnell A, García-Criado Á, et al. Diagnosis and staging of hepatocellular carcinoma (HCC): current guidelines. Eur J Radiol. 2018 Apr;101:72-81. https://doi.org/10.1016/j.ejrad.2018.01.025.

    Article  PubMed  Google Scholar 

  38. Fowler KJ, Potretzke TA, Hope TA, Costa EA, Wilson SR. LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma. Abdom Radiol (NY). 2018 Jan;43(1):149-157. https://doi.org/10.1007/s00261-017-1196-2.

    Article  PubMed  Google Scholar 

  39. Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, et al. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY). 2018 Jan;43(1):56-74. https://doi.org/10.1007/s00261-017-1325-y.

    Article  PubMed  Google Scholar 

  40. Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol. 2016 Mar;22(1):7-17. https://doi.org/10.3350/cmh.2016.22.1.7.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Golfieri R, Renzulli M, Lucidi V, Corcioni B, Trevisani F, Bolondi L. Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤ 2 cm) HCC in cirrhosis. Eur Radiol. 2011 Jun;21(6):1233-42. https://doi.org/10.1007/s00330-010-2030-1.

    Article  PubMed  Google Scholar 

  42. Jang HY, Choi JI, Lee YJ, Park MY, Yeo DM, Rha SE, Jung ES, You YK, Kim DG, Byun JY. Performance of Gadoxetic Acid–Enhanced Liver Magnetic Resonance Imaging for Predicting Patient Eligibility for Liver Transplantation Based on the Milan Criteria. J Comput Assist Tomogr. 2017 Jan;41(1):25-31. https://doi.org/10.1097/rct.0000000000000476.

    Article  PubMed  Google Scholar 

  43. Chernyak V, Fowler KJ, Heiken JP, Sirlin CB. Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS). J Magn Reson Imaging. 2019 May;49(5):1236-1252. https://doi.org/10.1002/jmri.26540.

    Article  PubMed  Google Scholar 

  44. Kromrey ML, Hori M, Goshima S, Kozaka K, Hyodo T, Nakamura Y, Nishie A, Tamada T, Shimizu T, Kanki A, Motosugi U. Gadoxetate disodium-related event during image acquisition: a prospective multi-institutional study for better MR practice. Eur Radiol. 2019 Jul 23. https://doi.org/10.1007/s00330-019-06358-7. [Epub ahead of print]

  45. Bashir MR, Huang R, Mayes N, Marin D, Berg CL, Nelson RC, Jaffe TA. Concordance of hypervascular liver nodule characterization between the organ procurement and transplant network and liver imaging reporting and data system classifications. J Magn Reson Imaging. 2015 Aug;42(2):305-14. https://doi.org/10.1002/jmri.24793.

    Article  PubMed  Google Scholar 

  46. Burgio MD, Picone D, Cabibbo G, Midiri M, Lagalla R, Brancatelli G. MR-imaging features of hepatocellular carcinoma capsule appearance in cirrhotic liver: comparison of gadoxetic acid and gadobenate dimeglumine. Abdom Radiol (NY). 2016 Aug;41(8):1546-54. https://doi.org/10.1007/s00261-016-0726-7.

    Article  Google Scholar 

  47. Kim DH, Choi SH, Kim SY, Kim MJ, Lee SS, Byun JH. Gadoxetic acid–enhanced MRI of hepatocellular carcinoma: value of washout in transitional and hepatobiliary phases. Radiology. 2019 Jun;291(3):651-657. https://doi.org/10.1148/radiol.2019182587.

    Article  PubMed  Google Scholar 

  48. Fowler KJ, Sirlin CB. Is It Time to Expand the Definition of Washout Appearance in LI-RADS? Radiology. 2019 Jun;291(3):658-659. https://doi.org/10.1148/radiol.2019190552.

    Article  PubMed  Google Scholar 

  49. Akai H, Kiryu S, Matsuda I, Satou J, Takao H, Tajima T, Watanabe Y, Imamura H, Kokudo N, Akahane M, Ohtomo K. Detection of hepatocellular carcinoma by Gd-EOB-DTPA-enhanced liver MRI: comparison with triple phase 64 detector row helical CT. Eur J Radiol. 2011 Nov;80(2):310-5. https://doi.org/10.1016/j.ejrad.2010.07.026.

    Article  PubMed  Google Scholar 

  50. Bashir MR, Gupta RT, Davenport MS, Allen BC, Jaffe TA, Ho LM, Boll DT, Merkle EM. Hepatocellular carcinoma in a North American population: Does hepatobiliary MR imaging with Gd‐EOB‐DTPA improve sensitivity and confidence for diagnosis J Magn Reson Imaging. 2013 Feb;37(2):398-406. https://doi.org/10.1002/jmri.23818.

    Article  Google Scholar 

  51. Lee S, Kim KW, Jeong WK, Kim MJ, Choi GH, Choi JS, Song GW, Lee SG. Gadoxetic acid–enhanced MRI as a predictor of recurrence of HCC after liver transplantation. Eur Radiol. 2019 Aug 30. https://doi.org/10.1007/s00330-019-06424-0.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Motosugi U, Murakami T, Lee JM, Fowler KJ, Heiken JP, Sirlin CB, LI‐RADS HBA Working Group. Recommendation for terminology: Nodules without arterial phase hyperenhancement and with hepatobiliary phase hypointensity in chronic liver disease. J Magn Reson Imaging. 2018 Nov;48(5):1169-1171. https://doi.org/10.1002/jmri.26515.

  53. Cha DI, Lee MW, Kim YK, Kim SH, Park HJ, Rhim H, Lim HK. Assessing patients with hepatocellular carcinoma meeting the milan criteria: is liver 3 tesla MR with gadoxetic acid necessary in addition to liver CT? J Magn Reson Imaging. 2014 Apr;39(4):842-52. https://doi.org/10.1002/jmri.24237.

    Article  PubMed  Google Scholar 

  54. Zheng RQ, Mao R, Ren J, Xu EJ, Liao M, Wang P, Lu MQ, Yang Y, Cai CJ, Chen GH. Contrast‐enhanced ultrasound for the evaluation of hepatic artery stenosis after liver transplantation: potential role in changing the clinical algorithm. Liver Transpl. 2010 Jun;16(6):729-35. https://doi.org/10.1002/lt.22054.

    Article  PubMed  Google Scholar 

  55. Wilson SR, Lyshchik A, Piscaglia F, Cosgrove D, Jang HJ, Sirlin C, Dietrich CF, Kim TK, Willmann JK, Kono Y. CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY). 2018 Jan;43(1):127-142. https://doi.org/10.1007/s00261-017-1250-0.

    Article  PubMed  Google Scholar 

  56. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/CEUS-LI-RADS-v2017 [accessed on 09/01/2019]

  57. Saviano A, Riccardi L, Zocco MA, Baumert T, Rapaccini GL, Pompili M, Gasbarrini A. Contrast-enhanced ultrasound for non-invasive diagnosis of hepatocellular carcinoma: A comparison between CEUS LI-RADS and ESCULAP criteria in a large high-risk cohort of patients. J Hepatol. 2018 Apr 1;68:S417-8.

    Article  Google Scholar 

  58. Schellhaas B, Hammon M, Strobel D, Pfeifer L, Kielisch C, Goertz RS, Cavallaro A, Janka R, Neurath MF, Uder M, Seuss H. Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS. Eur Radiol. 2018 Oct;28(10):4254-4264. https://doi.org/10.1007/s00330-018-5379-1.

    Article  PubMed  Google Scholar 

  59. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, Roberts LR, Heimbach JK. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018 Aug;68(2):723-750. https://doi.org/10.1002/hep.29913.

    Article  PubMed  Google Scholar 

  60. Schellhaas B, Görtz RS, Pfeifer L, Kielisch C, Neurath MF, Strobel D. Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of hepatocellular carcinoma: ESCULAP versus CEUS-LI-RADS. Eur J Gastroenterol Hepatol. 2017 Sep;29(9):1036-1044. https://doi.org/10.1097/meg.0000000000000916.

    Article  PubMed  Google Scholar 

  61. Terzi E, Iavarone M, Pompili M, Veronese L, Cabibbo G, Fraquelli M, et al. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter retrospective study of 1,006 nodules. J Hepatol. 2018 Mar;68(3):485-492. https://doi.org/10.1016/j.jhep.2017.11.007.

    Article  PubMed  Google Scholar 

  62. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, Zhu AX, Murad MH, Marrero JA. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018 Jan;67(1):358-380. https://doi.org/10.1002/hep.29086.

    Article  PubMed  Google Scholar 

  63. Parikh ND, Waljee AK, Singal AG. Downstaging hepatocellular carcinoma: a systematic review and pooled analysis. Liver Transpl. 2015 Sep;21(9):1142-52. https://doi.org/10.1002/lt.24169.

    Article  PubMed  Google Scholar 

  64. Yao FY, Fidelman N. Reassessing the boundaries of liver transplantation for hepatocellular carcinoma: Where do we stand with tumor down‐staging? Hepatology. 2016 Mar;63(3):1014-25. https://doi.org/10.1002/hep.28139.

    Article  PubMed  Google Scholar 

  65. Mehta N, Guy J, Frenette CT, Dodge JL, Osorio RW, Minteer WB, et al. Excellent outcomes of liver transplantation following down-staging of hepatocellular carcinoma to within Milan criteria: a Multicenter Study. Clin Gastroenterol Hepatol. 2018 Jun;16(6):955-964. https://doi.org/10.1016/j.cgh.2017.11.037.

    Article  PubMed  Google Scholar 

  66. Kielar A, Fowler KJ, Lewis S, Yaghmai V, Miller FH, Yarmohammadi H, et al. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY). 2018 Jan;43(1):218-230. https://doi.org/10.1007/s00261-017-1281-6.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Seo N, Kim MS, Park MS, Choi JY, Do RK, Han K, Kim MJ. Evaluation of treatment response in hepatocellular carcinoma in the explanted liver with Liver Imaging Reporting and Data System version 2017. Eur Radiol. 2019 Aug 15. https://doi.org/10.1007/s00330-019-06376-5.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Shropshire EL, Chaudhry M, Miller CM, Allen BC, Bozdogan E, Cardona DM et al. LI-RADS Treatment Response algorithm: performance and diagnostic accuracy. Radiology. 2019 Jul;292(1):226-234. https://doi.org/10.1148/radiol.2019182135.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Donati OF, Do RK, Hötker AM, Katz SS, Zheng J, Moskowitz CS, et al. Interreader and inter-test agreement in assessing treatment response following transarterial embolization for hepatocellular carcinoma. Eur Radiol. 2015 Sep;25(9):2779-88. https://doi.org/10.1007/s00330-015-3677-4.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Bonekamp D, Bonekamp S, Halappa VG, Geschwind JF, Eng J, Corona-Villalobos CP, et al. Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma. Eur J Radiol. 2014 Mar;83(3):487-96. https://doi.org/10.1016/j.ejrad.2013.11.016.

    Article  PubMed  Google Scholar 

  71. Rahman WT, Hussain HK, Parikh ND, Davenport MS. Reinterpretation of outside hospital MRI abdomen examinations in patients with cirrhosis: is the OPTN mandate necessary? AJR Am J Roentgenol. 2016 Oct;207(4):782-788. https://doi.org/10.2214/ajr.16.16209.

    Article  PubMed  Google Scholar 

  72. Ecker BL, Hoteit MA, Forde KA, Hsu CC, Reddy KR, Furth EE, et al. Patterns of discordance between pretransplant imaging stage of hepatocellular carcinoma and posttransplant pathologic stage: a contemporary appraisal of the Milan criteria. Transplantation. 2018 Apr;102(4):648-655. https://doi.org/10.1097/tp.0000000000002056.

    Article  PubMed  Google Scholar 

  73. Harper AM, Edwards E, Washburn WK, Heimbach J. An early look at the O rgan P rocurement and T ransplantation N etwork explant pathology form data. Liver Transpl. 2016 Jun;22(6):757-64. https://doi.org/10.1002/lt.24441.

    Article  PubMed  Google Scholar 

  74. Piscaglia F, Svegliati‐Baroni G, Barchetti A, Pecorelli A, Marinelli S, Tiribelli C, Bellentani S, HCC‐NAFLD Italian Study Group. Hepatology. 2016 Mar;63(3):827-38. https://doi.org/10.1002/hep.28368.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA

    Guilherme M. Cunha & Kathryn J. Fowler

  2. Department of Radiology, University of California, San Diego, CA, USA

    Dorathy E. Tamayo-Murillo & Kathryn J. Fowler

Authors
  1. Guilherme M. Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dorathy E. Tamayo-Murillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathryn J. Fowler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guilherme M. Cunha.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cunha, G.M., Tamayo-Murillo, D.E. & Fowler, K.J. LI-RADS and transplantation: challenges and controversies. Abdom Radiol 46, 29–42 (2021). https://doi.org/10.1007/s00261-019-02311-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-02311-w

Keywords

Search

Navigation