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Liver Imaging Reporting and Data System (LI-RADS) Print E-mail
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Written by G. Firman MD   
Tuesday, 28 November 2017 11:14


The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. 


Lesion Categories in LI-RADS (2017)

  • LR-NC (Not Categorizable): Lesion cannot be categorized owing to image degradation or omission
  • LR-1: Definitely benign
  • LR-2: Probably benign
  • LR-3: Intermediate probability of HCC
  • LR-4: Probably HCC
  • LR-5: Definitely HCC
  • LR-TIV (tumor in vein): Unequivocal enhancing soft-tissue TIV, regardless of the visualization of a parenchymal mass
  • LR-M: Targetoid mass or nontargetoid mass with one or more of the following: infiltrative appearance, marked diffusion restriction, necrosis or severe ischemia, other feature that in radiologist’s judgement suggests a non-HCC malignancy
  • LR-TR: Treatment response algorithm with the following categories: LR-TR nonevaluable, LR-TR nonviable, LR-TR equivocal, LR-TR viable


Contrast-enhanced ultrasound (CEUS) diagnostic table

 Arterial phase hyperenhancement. (APHE)

 No APHE

APHE 

(not rim**, not peripheral discontinuous globular***)

 Nodule size (mm)

 <20

 >/= 20

<10 

 >/= 10

 No washout of any type

 CEUS LR-3

 CEUS LR-3

 CEUS LR-3

 CEUS LR-4

 Late and mild washout

 CEUS LR-3

 CEUS LR-4

 CEUS LR-4

 CEUS LR-5

*CEUS LR-M criteria: any of following:

  • rim APHE OR.
  • early (< 60 s) washout OR.
  • marked washout

** rim APHE indicates CEUS LR-M

*** peripheral discontinuous globular indicates hemangioma (CEUS LR-1)


CT/MRI diagnostic table

 Arterial phase hyperenhancement (APHE)

 No APHE

 APHE (not rim)

 Observation size (mm)

 <20

 >/=20

 <10

 10-19

 >/=20

 Count major features:

  • “Washout” (not peripheral)
  • Enhancing “capsule”
  • Threshold growth


 None

 LR-3

 LR-3

 LR-3

 LR-3

 LR-4

 One

 LR-3

 LR-4

 LR-4

 LR-4*

 LR-5

 LR-5*

 >/= Two

 LR-4

 LR-4

 LR-4

 LR-5

 LR-5

*Observations in this cell are categorized LR-4 except as follows:

  • LR-5g, if there is >/= 50% diameter increase in < 6 months. These observations are equivalent to Organ Procurement and Transplantation Network (OPTN)  5A-g.
  • LR-5us, if there is both “washout” and visibility as discrete nodules at antecedent surveillance ultrasound, per American Association for the Study of Liver Diseases (AASLD) HCC criteria.




References:

  1. Tang A, Bashir MR, Corwin MT, Cruite I, Dietrich CF, Do RKG, Ehman EC, Fowler KJ, Hussain HK, Jha RC, Karam AR, Mamidipalli A, Marks RM, Mitchell DG, Morgan TA, Ohliger MA, Shah A, Vu KN, Sirlin CB; LI-RADS Evidence Working Group. Evidence Supporting LI-RADS Major Features for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review. Radiology. 2017 Nov 21:170554.  [Medline]
  2. Elsayes KM, Hooker JC, Agrons MM, Kielar AZ, Tang A, Fowler KJ, Chernyak V, Bashir MR, Kono Y, Do RK, Mitchell DG, Kamaya A, Hecht EM, Sirlin CB. 2017 Version of LI-RADS for CT and MR Imaging: An Update. Radiographics. 2017 Nov-Dec;37(7):1994-2017. [Medline]
  3. Kim TK, Noh SY, Wilson SR, Kono Y, Piscaglia F, Jang HJ, Lyshchik A, Dietrich CF, Willmann JK, Vezeridis A, Sirlin CB. Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 - a review of important differences compared to the CT/MRI system. Clin Mol Hepatol. 2017 Sep 15 [Medline]



Created Nov 28, 2017.

Last Updated on Friday, 15 December 2017 12:54
 

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