ArticleAbdominal radiology (New York)2026
LI-RADS TRA v2024 succeeds where RECIST and mRECIST fail: viability-based survival prediction in TACE-treated hepatocellular carcinoma.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDespite robust response assessment validation of Liver Imaging Reporting and Data System Treatment Response Algorithm (LI-RADS TRA) version 2024, a critical evidence gap exists for its prognostic value in non-radiation hepatocellular carcinoma (HCC) therapies. Conventional response assessment criteria (RECIST, mRECIST) focus on morphologic changes, not tumor viability. PURPOSE: To evaluate the prognostic implications of LI-RADS TRA v2024 versus RECIST and mRECIST for predicting overall survival and time to progression in HCC patients treated with trans-arterial chemoembolization (TACE), and to assess whether quantitative enhancement reduction augments prognostic stratification.
methodsA total of 105 HCC patients undergoing TACE with multi-phasic contrast-enhanced CT were included. Four board-certified radiologists independently assessed tumor response using LI-RADS TRA v2024, RECIST, and mRECIST criteria.
resultsLI-RADS TRA demonstrated convergent prognostic discrimination for overall survival, with non-responders achieving mean survival of 719.8 days versus responders 1,002.1 days (p = 0.014; hazard ratio 1.63). In contrast, RECIST (p = 0.670, hazard ratio 0.72) and mRECIST (p = 0.457, hazard ratio 1.16) showed negligible stratification. Importantly, LI-RADS TRA exhibited weak discrimination for time to progression (p = 0.095). Incorporating quantitative enhancement-size change from pre-TACE to post-TACE (%) substantially enhanced LI-RADS TRA prognostic performance for survival (HR 1.91, p = 0.026), but not progression prediction.
conclusionLI-RADS TRA v2024 outperforms conventional size-based and enhancement-duration criteria for mortality risk stratification in TACE-treated HCC, reflecting mechanistic potential of viability-based assessment. However, imaging response predicts cumulative mortality, not progression timing. Integration of quantitative enhancement metrics refines risk stratification for surveillance planning.
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