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

Abstract

Background: 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.

Objectives: 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.

Method: 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.

Results: 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%).

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

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