LIRADS (Advanced) (2025)-W6-CGI10-2025

Video Transcription

Video Summary

The session “LI-RADS Advanced,” moderated by Aya Kamiya, opened with Victoria Chernyak discussing evidence guiding proposed LI-RADS v2026 updates. Key goals are to simplify the algorithm while preserving LR-5 performance, especially a ≥95% positive predictive value (PPV), which is critical because LR-5 can justify HCC treatment without biopsy. Expansion to non-cirrhotic MASH/steatotic liver disease was explored due to rising HCC incidence, but current data show LR-5 criteria in this population do not meet the PPV target, with hepatocellular adenoma a common false positive—so expansion is not supported yet. Using a large individual participant data meta-analysis (~7,000 patients), the group found “threshold growth” is not independently associated with HCC specificity and can misclassify various malignancies; therefore, threshold growth is likely to be removed as a major feature and moved to an ancillary feature. Other potential simplifications under study include extending washout assessment to transitional/hepatobiliary phases and dichotomizing size at 10 mm. Ancillary features may be streamlined: separating “malignancy” vs “HCC-specific” ancillary features adds complexity without changing application, many features are rare (especially in LR-3 lesions), and future versions may reduce and possibly mandate a smaller set.<br /><br />James then reviewed HCC surveillance ultrasound and US LI-RADS evolution. Evidence supports ultrasound surveillance despite older meta-analyses using dated technology; validation studies show good specificity/NPV and useful PPV for US-3 recalls, especially in cirrhosis. Visualization score (VIS) strongly affects sensitivity: VIS C markedly lowers detection and also correlates with higher HCC risk. US LI-RADS Surveillance v2024 updates management: US should be performed in outpatients when possible; persistent sub-centimeter US-2 findings can return to routine surveillance sooner; elevated AFP prompts CT/MRI; and VIS C now guides alternate surveillance (e.g., abbreviated MRI) based on risk factors and persistence.<br /><br />A speaker from Shanghai summarized CEUS LI-RADS (2016), emphasizing real-time arterial hyperenhancement and washout patterns, distinctions between late/mild washout (LR-3/4/5) and early/marked washout (LR-M), and CEUS roles in problem-solving, biopsy guidance, and follow-up.<br /><br />Finally, LI-RADS Treatment Response v2024 changes were reviewed: for non-radiation therapies, viability is now any mass-like enhancement in any phase; for radiation-based therapies, “LR-TR non-progressing” replaces “equivocal” to reflect time-dependent effects. Diffusion/T2 ancillary MRI features can help resolve equivocal cases. New guidance allows applying treatment response at surgical margins to detect recurrence earlier, though more outcome and specificity data are needed.

Keywords

LI-RADS v2026 updates

LR-5 positive predictive value

non-cirrhotic MASH steatotic liver disease

threshold growth ancillary feature

washout assessment transitional hepatobiliary phases

10 mm size dichotomization

HCC surveillance ultrasound US LI-RADS v2024

visualization score VIS C abbreviated MRI

CEUS LI-RADS arterial hyperenhancement washout

LI-RADS Treatment Response v2024 LR-TR non-progressing