A. Eccher, Verona, IT

To evaluate the diagnostic performance of LI-RADS criteria in patients with hepatocellular carcinoma (HCC) after loco-regional treatments as a bridge to orthotopic liver transplantation (OLT).

Material and methods

27 patients (26M/1F, mean age 61 years) who underwent OLT after loco-regional treatments were included in this retrospective study. Liver lesions detected by pre-transplant imaging were assessed by 2 radiologists using LI-RADS criteria; the active disease burden was defined as the sum of the viable residual tumor among treated lesions and the maximum diameter of LI-RADS 4/5 lesions on preoperative imaging or overt HCCs on liver explant. Radiological data were compared to histopathological findings by using the Wilcoxon test.

Results

Among 40 treated lesions, pre-transplant imaging identified 24 completely necrotic lesions (60%) and 16 lesions with viable residual tumor (40%); complete pathological necrosis was found in 14/40 treated lesions (35%). Pre-transplant imaging additionally identified 10 non-treated lesions (5 LI-RADS 5; 5 LI-RADS 4); all LI-RADS 5 and 3 LI-RADS 4 lesions were HCCs at pathology, while 2 LI-RADS 4 lesions were regenerative nodules. The mean overall active disease burden was 11.7 mm (range, 0-38 mm) at preoperative imaging and 17.6 mm (range, 0-105.3 mm) at pathology (p=.192).

Conclusion

LI-RADS criteria are reliable for the identification of the HCC response to loco-regional treatment and for disease staging in patients undergoing OLT.

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