LI-RADS CT/MRI Nonradiation Treatment Response Assessment Version 2024 for Detecting Local Recurrence of Surgically Resected Hepatocellular Carcinoma.

Abstract

Background: LI-RADS CT/MRI Nonradiation Treatment Response Assessment (TRA) version 2024 (v2024) specifies that the updated algorithm may be applied for evaluating the surgical margin after hepatocellular carcinoma (HCC) resection. Objective: To compare detection of local recurrences after surgical resection of HCC between LI-RADS CT/MRI Nonradiation TRA v2024 and the LI-RADS CT/MRI Core version 2018 (v2018) diagnostic algorithm. Methods: This retrospective study included patients with surgically resected HCC who underwent at least one liver CT or MRI performed =6 months postoperatively. Two radiologists independently reviewed all postoperative CT and MRI examinations in included patients in separate sessions, assessing the surgical margin using LI-RADS CT/MRI Nonradiation TRA v2024 and LI-RADS CT/MRI Core v2018, respectively; a third radiologist resolved discrepancies. Local recurrence was defined by v2024 as LR-TR Viable (i.e., masslike enhancement at the margin, in any phase and of any size) and by v2018 as LR-5, LR-M, or LR-TIV. Results: The study included 200 patients (142 men, 58 women; median age 67 years) with median follow-up of 30.5 months. Interreader agreement for v2024 categorization was substantial (?=0.71). By v2024, LR-TR Viable at the surgical margin was assigned in 56 (28.0%) patients (on the initial postoperative examination in 21 patients, directly after an LR-Nonviable assignment without intervening LR-TR Equivocal assignment in 31 patients, and after an LR-TR Equivocal assignment in remaining patients), after a median of 5.1 months and at a median size of 1.5 cm. By v2018, LR-5, LR-M, or LR-TIV was assigned at the surgical margin in 53 (26.5%) patients after a median of 12.0 months (p<.001) and at a median size of 2.1 cm (p<.001). At the time of the 56 initial LR-TR Viable assignments, categories assigned for v2018 were LR-3, LR-4, LR-5, LR-M, and LR-TIV in 21, 10, 18, 3, and 4 patients, respectively. Upgrade of LR-3 and LR-4 observations to LR-5, LR-M, or LR-TIV occurred after a median of 5.1 and 3.0 months, respectively. Conclusion: v2024 detects local recurrence in 28% of patients, at an earlier time and smaller size than v2018. Clinical Impact: The findings support application of v2024 for surgical margin evaluation after HCC resection.

View details for DOI 10.2214/AJR.25.33787

View details for PubMedID 41190834