The New LI-RADS
The latest edition offers an expanded lexicon and clearer guidance for interpreting and reporting on imaging of the liver.
The Bulletin sat down with Claude B. Sirlin, MD, chair of the ACR Liver Imaging Reporting and Data System (LI-RADS),
to find out what's new with the latest edition of LI-RADS and why it's important to collaborate with other specialties and physicians across the globe.
Q: What's new in this edition of LI-RADS?
A:We've updated and simplified the LI-RADS process so that users are essentially navigating a decision tree that makes categorizing lesions much easier. We've also added an expanded and refined LI-RADS lexicon, an illustrative guide, and new content on hepatobiliary agents. It provides reporting templates for CT and MR, as well as reference cards for users to quickly refresh themselves. It also better aligns with the diagnostic recommendations advocated by the American Association for the Study of Liver Diseases (AASLD) and the Organ Procurement and Transportation Network (OPTN).
Q:Why is it important that LI-RADS align with the recommendations made by the AASLD and the OPTN?
A:We want to make LI-RADS as close as we can to other recommendations so that diagnosing liver disease is as standardized as possible. The OPTN has had one of the longest-running, most widely used sets of diagnostic recommendations; however, the recommendations only pertain to whether the case is serious enough to qualify for a transplant. Transplants are only one part of the patient's journey; we want to standardize the entirety.
Q:Why is it important that imaging specialists use LI-RADS?
A:LI-RADS is a comprehensive system for interpretation and reporting of imaging examinations in patients at risk for hepatocelluar carcinoma and includes precisely defined terminology and a diagnostic algorithm for categorization. LI-RADS was developed by expert radiologists with feedback from radiologists at various levels of training and with various levels of expertise from multiple institutions around the world.
Radiologists should use LI-RADS to reduce errors and variability in interpreting images and enhance communication with clinicians. Additionally, investigators should use LI-RADS terminology in their research to permit reliable comparisons across studies, pooling of results, and meta-analysis of data. Eventually, the widespread use of LI-RADS may lead to the development of national and international research registries, which will help advance knowledge and clinical care.
Q:What was the process for creating LI-RADS?
A:LI-RADS was created through an iterative process of development, testing, feedback, and refinement. In 2008, the ACR convened a committee of 11 radiologists to develop LI-RADS. This edition of LI-RADS has been created by a number of working groups made up of diagnostic radiologists, interventional radiologists, hepatologists, surgeons, and pathologists. Our working groups also included international input, with representatives from Canada, South America, Europe, and Asia. Each working group developed content specific to its area of expertise. The Atlas and Lexicon Working Group integrated the content developed by each working group into the new edition. The first version of LI-RADS was released in 2011. Major updates were released in 2013 and in 2014.
Q:How does having a diverse group participate in the update process aid lexicons such as LI-RADS?
A:Having a variety of voices means that we can create something that meets everyone's needs, no matter their specialty, association, or nationality. We reached out to our international partners because the level of treatment varies from country to country — some countries, for example, may diagnose and treat cancer more aggressively than others. With input from around the world, we were able to reach a general consensus on determining category recommendations.
Q:Why was there a need for a new edition?
A:The most important reason was to address hepatobiliary agents. These agents are used in many centers throughout the world for diagnosis and staging of hepatocellular carcinoma, yet there was no standardized system for interpreting and reporting liver lesions using these agents. The new edition of LI-RADS fills this gap. Additionally, radiologists are always looking for ways to enhance our knowledge, and new editions allow for that.
Q:How can users access LI-RADS?