LI-RADS Management Working Group Summary Statement

• EASL and AASLD guidelines address the management of lesions that are definitely HCC by imaging criteria (LI-RADS 5). LI-RADS expands the “indeterminate” category into probably benign, intermediate probability of HCC, and probably HCC (LR-2, LR-3, and LR-4). LI-RADS numerical categories apply to patients who are candidates for, or who are already enrolled in, a surveillance program for HCC, and are not designed to describe incidental findings in patients at low risk for HCC.
• LI-RADS categories are based on contrast-enhanced imaging findings in patients at risk for HCC, without regard to other clinical information that may or may not be available to the radiologists. However, for observations without a definite diagnosis by imaging (LR-2, LR-3, and LR-4), a clinician’s estimated probability of HCC depends not only on the LI-RADS category but also on factors such as biomarkers and the patient's prior probability of developing or having HCC.
• Decisions between accelerated follow-up (shorter than standard surveillance interval), alternative imaging, biopsy or treatment without biopsy, do not follow directly from the LI-RADS category or from a clinician’s estimated probability of HCC, but rather from a clinical assessment that integrates all available medical information, including patient co-morbidities and patient preference.
• A category of LR-2, LR-3 or LR-4 should be issued along with a diagnostic recommendation. This recommendation may include: to continue routine surveillance, repeat imaging at shorter than routine interval (accelerated follow-up), or repeat imaging using a different method (alternative imaging), and/or engage in multidisciplinary discussion. A recommendation for biopsy or treatment should not follow directly from an imaging interpretation, but should be the result of multidisciplinary discussion. Diagnostic options are listed in the accompanying table.