Contrast Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®): the official version by the American College of Radiology (ACR)

Abstract

We read with interest the article by Schellhaas et al (B. Schellhaas et al. Ultraschall in Med 2016; 37: 627-634). While their study may contribute to the ongoing validation of CEUS as a non-invasive method for HCC diagnosis in at-risk patients, we take exception to their inappropriate and misleading adoption of the term "CEUS-LI-RADS". Based on good evidence (A. Sangiovan

Treatment of Combined Hepatocellular and Cholangiocarcinoma

“…It should be underlined that all of these tests are primarily performed to distinguish HCC (the most common malignancy in cirrhotic livers) from benign nodules, and not because HCC-CC is suspected. For this aim, specific liver imaging reporting and data system (LI-RADS) classifications have been proposed for the three main diagnostic techniques [8,9]. In the LI-RADS classification, liver lesions are categorized on a scale ranging from LR-1 (definitely benign) to LR-5 (definitely HCC) according to their contrast pattern.…”

“…Lesions showing definite signs of malignancy but patterns that are atypical for HCC (for instance, rim-like arterial enhancement, early or marked washout) are categorized as "LI-RADS metastasis" (LR-M). Usually, LR-M nodules are expressions of undifferentiated HCC, other primary liver cancers (including HCC-CC), or metastasis [8,9]. As these different medical conditions require specific therapeutic strategies, LR-M nodules should undergo a biopsy for a systematic characterization.…”

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“…Practitioners need to be competent in the intravenous administration of contrast agents, be familiar with contraindications and be able to manage any possible adverse effects within the medical and legal framework of their country [4,38]. We refer to the educational activities of the collaborating societies of this paper, the World Federation of Ultrasound in Medicine and Biology (WFUMB) [9,23,[93][94][95][96][97][98][99][100][101][102], the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [1,3,4,11,37,38,49,50,74,79,[103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119] and the CEUS LI-RADS Working Group for Liver Imaging Reporting and Data System (LI-RADS®) [34][35][36][120]…”

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].…”

“…Mit der Zulassung des Kontrastmittels SonoVue™ in den USA (als Lumason™) wurde die LI-RADS-Kategorisierung auch auf die Kontrastmittelsonografie (engl. "contrast enhanced ultrasound", CEUS) erweitert [20,26,27]. Die Abkürzung (Akronym) CEUS ist ein akzeptierter Begriff für die Kontrastmittelsonografie und wurde 2004 durch die Europäische Ultraschallgesellschaft (EFSUMB, European Federation of Societies for Ultrasound in Medicine and Biology) eingeführt [15].…”