LIMITATIONS OF LIRADS: Course of LIRADS 3 & 4

 

LIMITATIONS OF LIRADS: Course of LIRADS 3 & 4 on Imaging

There is a limitation of of LIRADS, that small or early HCC are more likely to be improperly characterized as LIRADS 3 & 4

Studies have suggested that, a large majority of LIRADS 4 and less than half of the LR 3 progress to LR 5. 

LR 3 are relatively stable; whereas, LR 4 lesions have twice the rate of progression to LR 5

A meta-analysis by van der Pol et al found 38 % LR-3 observations progressed to HCC; whereas, in a study done by Damithri et al, they found progression of LR-3 to HCC in 11%. 

Panita et al  found HCC in explant liver missed on imaging were < 1 cm. 

Older patients & those with viral disease are more likely to present as LR 5. 

Younger patient & non viral disease may present as LR 3 or 4, which warrant close observation. 

Some of these lesions are also labelled as follow: 

SHNHRs: Subcentimter hypervascular nodular nodules at high risk for developing into HCC

SAELs: Subcentimter arterially enhancing & hepatobiliary hypointense lesions

Summary:

Reliance solely on Imaging in LIRADS 3/4 should be avoided & more active management strategy might be warranted. 

Prepared by Dr. Sharad Maheshwari

08.12.2023

Updated: 09.12.2023

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257948/

2. https://pubmed.ncbi.nlm.nih.gov/29133247/

3. https://pubmed.ncbi.nlm.nih.gov/30445016/

4. https://www.ajronline.org/doi/pdf/10.2214/AJR.21.26376

5. https://pubmed.ncbi.nlm.nih.gov/30445016/