Evaluation of Indeterminate Liver Lesions (LR-3 and LR-4)

The Liver Imaging Reporting and Data System (LI-RADS) standardizes imaging interpretation for liver lesions. Our group has a particular interest in indeterminate liver lesions (LI-RADS-3 and LR-4), which present challenges in clinical decision-making. We have led studies characterizing their natural history, including risk of developing HCC, and defined recommended management algorithms. As a site in the Translational Liver Cancer Consortium (TLC), we are prospectively enrolling patients with LR-3 and LR-4 patients to evaluate blood- and imaging-based strategies for risk stratification and early detection of HCC.

Van der Pol CB*, Lim CS*, Sirlin CB, McGrath TA, Salameh J, Bashir MR, Tang A, Singal AG, Costa AF, Fowler K, McInnes M. Accuracy of the Liver Imaging Reporting and Data System on Computed Tomography and Magnetic Resonance Imaging – A Systematic Review. Gastroenterology 2019; 156(4): 976-986.
Kanneganti M, Marrero J, Parikh ND, Kanwal F, Yokoo T, Mendiritta-Lala M, Rich NE, Gopal P, Singal AG. Clinical Outcomes of Patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 Observations in Patients with Cirrhosis. Liver Transplantation 2022; 28(12): 1865-75.
Dunn C*, Lin B*, Rich NE, Patel M, Gopal P*, Singal AG*. Correlation of LI-RADS 3 or 4 Observations with Histopathologic Diagnosis in Patients with Cirrhosis. Clinical Gastroenterology and Hepatology 2023; 21(5): 1351-1353.e2
Singal AG, Parikh ND, Shetty K, Han S-H, Xie C, Ning J, Rinaudo J, Arvind A, Lok AS, Kanwal F, Translational Liver Cancer Investigators. Natural History of Indeterminate Nodules in Patients with Advanced Liver Disease: A multi-center retrospective cohort study. Am J Gastroenterology 2024; 119(11): 2251-2258.
Yokoo T, Singal AG, Diaz de Leon A, Ananthakrishnan L, Fetzer DT, Pedrosa I, Khatri G. Prevalence and clinical impact of discordant liver observation LI-RADS reporting among abdominal radiologists on multiphase contrast-enhanced MRI in patients with cirrhosis. Abdominal radiology 2020; 45(1): 177-87.
Singal AG, Taouli B, Gopal P, Kanwal F, Parikh ND. Evaluation of LR-3 and LR-4 lesions. Gastroenterology 2025; 168(4): 667-674.