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<p>The Liver Imaging Reporting and Data System (LI-RADS) has become an essential tool for standardizing the detection, diagnosis, and treatment response assessment of hepatocellular carcinoma (HCC) using contrast-enhanced CT and MRI. With the rising incidence of HCC, the use of local–regional therapies (LRT) has also expanded. To address the increasing complexity of post-treatment imaging interpretation, the LI-RADS Treatment Response Assessment (TRA) algorithm was developed to provide a structured and reproducible approach for evaluating tumor response following various forms of LRT. However, imaging features following radiation-based therapies—such as transarterial radioembolization and stereotactic body radiation therapy—often differ from those seen after thermal ablation and transarterial chemoembolization. Recognizing these differences, the 2024 LI-RADS TRA update introduces refinements to improve diagnostic accuracy in this context. This review outlines the evolving role of LI-RADS in post-treatment assessment, highlights imaging findings associated with different LRTs, and explores ongoing refinements aimed at optimizing its clinical utility. Finally, we discuss the need for prospective validation of the new algorithm to confirm its diagnostic performance and clinical impact.</p>

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LI-RADS TRA V2024: innovations in imaging assessment of hepatocellular carcinoma response to locoregional therapies

  • 期刊论文

  • 发表日期：

    2025年8月27日

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  • Alexandre Key Wakate Teruya,
  • Joao Miranda,
  • Hilton Leão Filho,
  • Daniel Lahan-Martins,
  • Cassia Tamura Sttefano Guimaraes,
  • Roberto Blasbalg,
  • Fernanda Garozzo Velloni

摘要

The Liver Imaging Reporting and Data System (LI-RADS) has become an essential tool for standardizing the detection, diagnosis, and treatment response assessment of hepatocellular carcinoma (HCC) using contrast-enhanced CT and MRI. With the rising incidence of HCC, the use of local–regional therapies (LRT) has also expanded. To address the increasing complexity of post-treatment imaging interpretation, the LI-RADS Treatment Response Assessment (TRA) algorithm was developed to provide a structured and reproducible approach for evaluating tumor response following various forms of LRT. However, imaging features following radiation-based therapies—such as transarterial radioembolization and stereotactic body radiation therapy—often differ from those seen after thermal ablation and transarterial chemoembolization. Recognizing these differences, the 2024 LI-RADS TRA update introduces refinements to improve diagnostic accuracy in this context. This review outlines the evolving role of LI-RADS in post-treatment assessment, highlights imaging findings associated with different LRTs, and explores ongoing refinements aimed at optimizing its clinical utility. Finally, we discuss the need for prospective validation of the new algorithm to confirm its diagnostic performance and clinical impact.