LiverImagingGroupResearchProgramYeseniaCovarrubias,B.S.AnthonyGamst,Ph.D.GavinHamilton,Ph.D.WillHaufe,B.S.ElhamyHeba,M.D.CatherineHooker,B.S.JonathanHooker,B.S.AdrijaMamidipalli,M.D.PaulManning,MSIVMichaelS.Middleton,M.D.,Ph.D.

PaulMurphy,M.D.,Ph.D.CharliePark,MSIIIHakanSahin,M.D.AlexSchlein,B.S.ClaudeB.Sirlin,M.D.NikolausSzeverenyi,Ph.D.TydusThai,MSIIKangWang,MSIVTanyaWolfson,B.S.

R01DK075128,R01DK088925,R56DK090350,U01DC061734,R01DK106419,T32EB005970,CIPPilotGrant,GrantsfromGEandSiemens

Vision•  Improvethelivesofpeoplewithoratriskfordevelopinglivercancer• Develop&validateimagingmethodstodetect,diagnose,andcharacterizelivercanceroritsprecursorcondiOons

WhyLiverCancer?•  2ndmostcommoncauseofcancerdeathworldwide• Mostrapidlygrowingcauseofcancerdeath•  DisproporOonatelyaffectsCA,SD•  Biologicalspectrum•  Caniden(fypopula(onatrisk•  Canimagepre-neoplas(ccondi(ons

LiverFat LiverFibrosis LiverCancerObesity

MRIProtonDensityFatFracSon

PDFF5.4%

PDFF25.0%

Baseline

PostTreatment

BodyComposiSonProfiling

MRElastography

2.67kPa

3.23kPa

Baseline

PostTreatment

AbbreviatedMRI

LI-RADS

àObesitytrialsatUCSD àClinicalcare àNASHtrialsatUCSD àClinicalcare àClinicalcare

LR-5g, if there is ≥ 50% diameter increase in ≤ 6 months (equivalent to OPTN 5A-g). LR-5us if there is both “washout” and visibility as nodules at antecedent surveillance ultrasound (AASLD HCC criteria). LR-4 otherwise.

LR-4LR-5

Definitely benign

Probably benign

Neither definitely nor probably benign

LR-1 LR-2

Untreated observation

LR-5V

Probable malignancy, not specific for HCC LR-M

Tumor in vein

Treated observation

LR-Treated

Observation in high-risk patient

Apply ancillary features and then tie-breaking rules to adjust category

< 20mm ≥ 20mm < 10mm 10-19mm ≥ 20mm

LR-3 LR-3 LR-3 LR-4LR-3LR-3 LR-4 LR-4 LR-5LR-4 LR-4 LR-5 LR-5LR-4

LR-4LR-5

NoneOne

≥ Two

+

+�Capsule�

Threshold Growth

=

Measure diameter

Arterial phase hypo-or iso-

enhancement

Arterial phase hyperenhancement(excluding rim enhancement)

LI-RADS Table

Count number offeatures below:�Washout�

(excluding peripheral “washout”)

DevelopedatAMRAValidatedinpartatUCSD

DevelopedatUCSDincollaboraOonwithUW

DevelopedatMayoValidatedinpartatUCSD

DevelopedatUCSD DevelopedatUCSD

54-yo man with HCV cirrhosis

T1 OP T2w SSFSE DWI

18 mm

AP PVP 3 min

What’sNext?•  SPORE:•  SpecializedPrograminResearchExcellence

•  LivercancertranslaOonalresearch•  UCSD–SDSU–SanfordBurnham

Centraltheme:Imaging