Cirrhotic liver: What's that nodule? The LI‐RADS approach

Abstract

The Liver Imaging Reporting and Data System (LI-RADS) is an American College of Radiology (ACR)-endorsed diagnostic system of standardized terminology, interpretation, and reporting for imaging examinations of the liver in patients at high risk for hepatocellular carcinoma (HCC). LI-RADS assigns a category to observations in the liver indicating the likelihood of benignity or HCC. LI-RADS categories include LR-1: Definitely Benign, LR-2: Probably Benign, LR-3: Intermediate Probability for HCC, LR-4: Probably HCC, LR-5: Definite HCC, LR-5V: Definite HCC with Tumor in Vein, LR-Treated: Treated HCC, LR-M Probable Malignancy, not specific for HCC. This article reviews the types of nodules seen in the cirrhotic liver, examines core LI-RADS concepts and definitions, and utilizes the LI-RADS v2014 algorithm to categorize representative observations depicted at magnetic resonance imaging in a case-based approach.

Diagnosis of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology

“…However, the main concern regarding inclusion of the TP for determining washout appearance is that, the definition of hypointensity in the TP differs from that in the DP in ECCM-enhanced imaging. Since gadoxetic acid uptake by hepatocytes begins as early as the end of the PVP, hypointensity in the TP might be due to the combined effect of de-enhancement and lack of hepatocyte relative to the surrounding liver parenchyma (3549). This “pseudo-washout” can be observed in high-flow hemangiomas (50) and other non-hepatocyte-containing lesions, which decreases the specificity of diagnosis of HCCs, including hypervascular intrahepatic cholangiocarcinomas (ICC) (475152).…”

Non-invasive diagnosis of hepatocellular carcinoma revisited

“…It allows a standardised risk stratification under consideration of multiple, precisely defined parameters 6. LI-RADS recommends late arterial phase imaging, because some HCCs may show hyperenhancement only in the late arterial phase 6. In our cohort 51% (36/70) of CT scans, 50% (14/28) of conventional MRI, and 45% (20/44) of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-MRI were obtained in late arterial phase.…”

“…To improve standardisation and consensus regarding the imaging diagnosis of HCC, the Liver Imaging Reporting and Data System (LI-RADS) was launched 6. It allows a standardised risk stratification under consideration of multiple, precisely defined parameters 6.…”

“…It allows a standardised risk stratification under consideration of multiple, precisely defined parameters 6. LI-RADS recommends late arterial phase imaging, because some HCCs may show hyperenhancement only in the late arterial phase 6.…”

Standardisierte Befundung und Dokumentation der Kontrastmittelsonografie der Leber (CEUS LI-RADS)

“…Die Kategorie LR-5V repräsentiert ein bildgebend gesichertes HCC mit Pfortaderinfiltration, auch wenn eine parenchymatöse extravasale Tumor-Komponente des sicher durchbluteten Tumorthrombus nicht identifiziert werden kann. Die Kategorie LR-M wird für Observationen genutzt, die definitiv oder wahrscheinlich maligne sind, aber bildmorphologisch Merkmale aufweisen, die nicht spezifisch für das HCC sind [3,7,20]. Die Differenzialdiagnose solcher Leberläsionen beinhaltet das atypische HCC und Nicht-HCC-Malignome, wie zum Beispiel das intrahepatische Cholangiokarzinom (ICC) oder Lebermetastasen [21 -25].…”