Abstract
BACKGROUND: The effectiveness of Liver Imaging Reporting and Data System treatment response algorithm version 2024 (LR-TRA v2024) in hepatocellular carcinoma (HCC) patients undergoing locoregional plus systemic combination therapy remains uncertain. We aimed to investigate the performance of LR-TRA v2024 on magnetic resonance imaging (MRI) in detecting residual HCC following transarterial chemoembolization (TACE) plus systemic therapy. METHODS: This single-center retrospective study included consecutive adult patients who received TACE plus systemic therapy for HCC and subsequent surgical resection (July 2019 to November 2023). All contrast-enhanced preoperative MRIs were independently evaluated by three blinded radiologists for LR-TR, Liver Imaging Reporting and Data System treatment response (LR-TR) categories and two ancillary features. Postoperative pathology was used as the reference standard for residual tumors, which was further categorized as any (>0%) or major (>10%) residual tumors. When investigating the performances of LR-TR categories, the LR-TR Equivocal category was grouped into the LR-TR Viable category. The diagnostic performances were evaluated using positive predicting value (PPV) and negative predicting value (NPV). RESULTS: Fifty-one patients (median age, 56 years; 45 males) with 63 HCCs were included. For the detection of any residual tumor, the per-lesion PPV and NPV of the LR-TR Viable category were 100.0% and 46.9%, respectively; the per-patient PPV and NPV were 100.0% and 45.5%, respectively. For the detection of major residual tumor, the per-lesion PPV and NPV of the LR-TR Viable category were 80.6% and 84.4%, respectively; the per-patient PPV and NPV were 82.8% and 86.4%, respectively. CONCLUSIONS: LR-TRA v2024 was effective in evaluating treatment response and detecting residuals of HCC to TACE plus systemic therapy.