# Knowledge, attitudes and current practices regarding LI-RADS®: A survey from 14 countries in sub-Saharan Africa

## TL;DR

This study surveyed medical professionals in sub-Saharan Africa to assess their knowledge and use of LI-RADS, a system for diagnosing liver cancer, finding significant gaps and a need for better training.

## Contribution

The study identifies gaps in LI-RADS knowledge and adoption in sub-Saharan Africa and suggests targeted educational interventions.

## Key findings

- Radiologists outperformed non-radiologists in LI-RADS knowledge but many were unaware of its limitations.
- Only a minority of respondents used LI-RADS as their standard reporting system.
- Lack of consistency and unfamiliarity were the main barriers to adopting LI-RADS.

## Abstract

Hepatocellular carcinoma (HCC) is highly prevalent in sub-Saharan Africa (SSA). LI-RADS® is a standardised system for imaging-based diagnosis and characterisation of HCC.

This study assessed knowledge, attitudes and current practices related to LI-RADS in SSA, with a view to identifying barriers to its utilisation and informing targeted educational interventions.

A 21-item anonymous electronic questionnaire was distributed to medical professionals in SSA using the SurveyMonkey online platform. Knowledge, attitudes and current practices regarding LI-RADS® were assessed. Data were analysed using descriptive statistics, and comparisons were made between radiologists and non-radiologists.

There were 134 respondents from 14 of the 34 SSA countries. Radiologists significantly outperformed non-radiologists in LI-RADS® knowledge, particularly regarding its purpose (65.6% vs 38.2%, p = 0.0007), arterial phase hyperenhancement definition (90.3% vs 59.8%, p = 0.004) and size criteria (77.4% vs 45.1%, p = 0.003) for diagnosing hepatocellular carcinoma (HCC). However, 43.8% of radiologists and 63.4% of non-radiologists did not recognise the limitations of LI-RADS®. Only 34.3% stated that LI-RADS® was their reporting standard and 29.1% of the respondents indicated that less than 25% of their radiological reports adhered to LI-RADS®. The majority (78.3%) of participants stated they preferred radiology reports for high-risk liver lesions to be LI-RADS®-standardised. The two main barriers to adopting LI-RADS® included lack of consistency (44.8%) and unfamiliarity with the reporting system (27.6%).

Although LI-RADS® remains the preferred reporting system for HCC, there are significant gaps in its knowledge and implementation across SSA.

This survey highlights the needs for targeted educational initiatives and improved training to enhance the adoption and use of LI-RADS® in SSA.