Reply to “Standardizing diffusion-weighted imaging in LI-RADS for diagnosis of hepatocellular carcinoma”.

The article is a reply to a commentary on the role of diffusion-weighted imaging (DWI) in the diagnosis of hepatocellular carcinoma (HCC) and its implication in the Liver Imaging Reporting and Data System (LI-RADS). The authors agree that DWI should be incorporated into the standard liver protocol and should include at least one acquisition with a high b-value. However, they note that restricted diffusion, although associated with the diagnosis of liver malignancies, is considered an ancillary feature in the LI-RADS algorithm and cannot be used to diagnose HCC noninvasively in the absence of other major features. They also suggest that contrast-enhanced ultrasound (CEUS) can serve as an alternative technique to confirm the diagnosis of HCC in patients with contraindications to CT/MRI contrast agent administration. In conclusion, while DWI is essential for the detection and characterization of focal liver lesions, the noninvasive diagnosis of definitive HCC can only be reached through contrast-enhanced imaging. [Extracted from the article]