Contrast Enhanced Ultrasound: Liver Imaging Reporting and Data System (CEUS LI-RADS)

Hepatocellular carcinoma (HCC) is the 5th common cancer and 2nd leading cause of cancer death worldwide. All society guidelines support the use of imaging to establish the noninvasive diagnosis of HCC without confirmatory biopsy if imaging is definitive. Therefore, accurate imaging is vital in HCC patient management. The American College of Radiology (ACR) endorsed the Liver Imaging Reporting and Data System (LI-RADS) for standardized reporting and data collection of computed tomography (CT) and magnetic resonance (MR) imaging for hepatocellular carcinoma (HCC) in high-risk patients in 2011 [http://www.acr.org/quality-safety/resources/LIRADS]. Originally developed for CT and MRI, LI-RADS was expanded in 2016 to include CEUS coincident with the approval in the United States of a microbubble contrast agent for liver imaging (Lumason®, known as SonoVue® in Europe and elsewhere). CEUS LI-RADS currently includes 8 categories to codify the probability of HCC based on imaging. The categories range from definitely benign (LR-1) to definitely HCC (LR-5). Observations categorized as LR-5 can be managed as HCC without histological confirmation. CEUS LI-RADS also includes a separate category (LR-M) for observations that are definitely or probably malignant, but with imaging features not specific for HCC. The differential diagnosis for such lesions includes atypical HCC and intrahepatic cholangiocarcinoma (ICC); biopsy may be needed to distinguish these possibilities. LR-TIV (tumor in vein) is assigned for observations with definite tumor in vein, even if a parenchymal component is not identified at imaging; biopsy is not needed to confirm the vascular invasion but may be needed to determine the underlying tumor type. LR-NC (not categorizable) is assigned to observations that cannot be categorized due to image degradation or omission. The details of categories, algorithm, major features, and ancillary features can be downloaded from the ACR website (https://www.acr.org/Quality-Safety/Resources/LIRADS). The presentation will summarize the updated version of CEUS-LI-RADS (v2017). 1. Dietrich CF, Kono Y, Cosgrove D, Jang HJ, Kim TK Piscaglia F, Sirlin CB, Willmann JK, Vezeridis A, Wilson SR, Lyshchik A. Contrast-Enhanced Ultrasound: Liver Imaging Reporting and Data System (CEUS LI-RADS). Solutions in contrast imaging 2016;3: N.3. Piscaglia F, Wilson SR, Lyshchik A, Cosgrove D, Dietrich CF, Jang HJ, Kim TK, Salvatore V, Willmann JK, Sirlin CB, Kono Y. American College of Radiology Contrast Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for the diagnosis of Hepatocellular Carcinoma: a pictorial essay. Ultraschall Med. 2017;38:320-324.