Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 – a review of important differences compared to the CT/MRI system

Abstract

Medical imaging plays an important role in the diagnosis and management of hepatocellular carcinoma (HCC). The Liver Imaging Reporting and Data System (LI-RADS) was initially created to standardize the reporting and data collection of CT and MR imaging for patients at risk for HCC. As contrast-enhanced ultrasound (CEUS) has been widely used in clinical practice, it has recently been added to the LI-RADS. While CEUS LI-RADS shares fundamental concepts with CT/MRI LI-RADS, there are key differences between the modalities reflecting dissimilarities in the underlying methods of image acquisition and types of contrast material. This review introduces a recent update of CEUS LI-RADS and explains the key differences from CT/MRI LI-RADS.

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

“…There is controversy on the differential diagnosis of HCC and ICC with CEUS [35,52,93,[130][131][132][133][134][135][136][137]. Compared to HCC, ICC shows a less intense enhancement in the AP and shows early (< 60 seconds) and marked washout compared to a typically late and mild washout in HCC [93].…”

LI‐RADS 2017: An update

“…These include introduction of an ultrasound screening algorithm and CEUS diagnostic algorithm. 19 Additionally, a new “tumor response evaluation” algorithm was introduced for use with CT or MRI in the follow-up of patients who have undergone various types of locoregional therapy for presumed or pathologically proven HCC 20 (Fig. 6).…”

“…After injection of a contrast agent either for CT or MRI, it can be a challenge to determine if there is enhancement or simply “shinethrough” of the intrinsic brightness of the treated lesion: By performing subtraction imaging on MRI, areas of residual disease can be identified more confidently. 19 …”

“…After injection of a contrast agent either for CT or MRI, it can be a challenge to determine if there is enhancement or simply "shinethrough" of the intrinsic brightness of the treated lesion: By performing subtraction imaging on MRI, areas of residual disease can be identified more confidently. 19 In patients undergoing transarterial chemoembolization (TACE), a hyperdense substance, iodized oil, is often injected at the time of the fluoroscopically guided procedure. 26 Iodized oil, based on poppy seed oil, can be used as a radio-opaque intra-arterially administered contrast agent.…”

Introduction to the Liver Imaging Reporting and Data System for Hepatocellular Carcinoma

“…Detailed information on LI-RADS is available on the ACR LI-RADS website 2 and in recent publications. 2,5,6 Liver Imaging Reporting and Data System Development: Rationale and History…”