LI-RADS treatment response algorithm after first-line DEB-TACE: reproducibility and prognostic value at initial post-treatment CT/MRI

Ali Pirasteh, E. Aleks Sorra, Hector Marquez, Robert C. Sibley, Julia R. Fielding, Abhinav Vij, Nicole E. Rich, Ana Arroyo, Adam C. Yopp, Gaurav Khatri, Amit G. Singal, Takeshi Yokoo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: To evaluate the inter-reader reproducibility and prognostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (LR-TR) at the time of initial post-treatment evaluation following drug-eluting beads transarterial chemoembolization (DEB-TACE) for hepatocellular carcinoma (HCC). Methods: This retrospective study included patients with HCC who underwent first-line DEB-TACE between January 2011 and December 2015. Six readers (three fellowship-trained radiologists and three radiology trainees) independently assessed lesion-level response in up to two treated lesions per LR-TR and modified Response Evaluation Criteria in Solid Tumors (mRECIST)-target criteria, as well as patient-level response per mRECIST-overall criteria, on the initial post-treatment CT/MRI. Inter-reader agreement was calculated by Fleiss’ multi-reader κ. We tested whether LR-TR, mRECIST-target, and mRECIST-overall response were associated with overall survival using Kaplan–Meier and Cox proportional hazard model analyses. Results: A total of 82 patients with 113 treated target lesions were included. Inter-reader agreement was moderate for LR-TR and mRECIST-overall (κ range 0.42–0.57), and substantial for mRECIST-target (κ range 0.62–0.66), among all three reader-groups: all readers, experienced readers, and less-experienced readers. LR-TR and mRECIST-target response were not significantly associated with overall survival regardless of reader experience (P > 0.05). In contrast, mRECIST-overall response was significantly associated with overall survival when assessed by all readers (P = 0.02) and experienced readers (P = 0.03), but not by the less-experienced readers (P = 0.35). Conclusion: Although LR-TR algorithm has moderate inter-reader reproducibility, it alone may not predict overall survival on the initial post-treatment CT/MRI after first-line DEB-TACE for HCC.

Original languageEnglish (US)
Pages (from-to)3708-3716
Number of pages9
JournalAbdominal Radiology
Issue number8
StatePublished - Aug 2021


  • Computed tomography
  • Hepatocellular carcinoma
  • Magnetic resonance imaging
  • Response Evaluation Criteria In Solid Tumors
  • Therapeutic chemoembolization

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology


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