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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
History of LI-RADS
The first version of LI-RADS was released in 2011 by the ACR
(American College of Radiology)
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
International Consideration
A long-term goal of LI-RADS is to unify HCC imaging and
diagnosis worldwide
• United States liver transplantation for HCC
• Asia early HCC detection for primary resection or
local-regional therapy
US LI-RADS Surveilance
Contrast material-
enhance US LI-RADS
Diagnosis
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
LI-RADS OBSERVATION
LI-RADS observation an area with imaging appearance of the liver:
- true lesion or a pseudolesion
- benign to neoplastic
- premalignant to malignant
- Hepatocellular or nonhepatocellular
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Changes in Categorization
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Journal of Radiology.289(3):1-15
Changes in Threshold growth
definition
Only 50% size increase in 6 months or less qualifies as threshold growth; all other size increases
qualify as subthreshold growth.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
US LI-RADS
US For Surveillance
Repeated application of a
diagnostic test at a defined
interval in a population at
risk for developing a
disease
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
US Categories
Cirrochis with
ascites but no focal
liver observation
Hyperechoic observation
is identified that follow up
in 3-6 month to ensure
stability
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Solid hypoechoic >10mm in left New thrombus in main Parenchymal distortion resulting
lobe of the liver portal vein in loss of normal portal triads
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Journal of Radiology.289(3):1-15
CT/MRI
For Diagnosis
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
CT/MRI
Technique
Intravenous extracellular contrast agents are used for CT.
Extracelluler or hepatobilier used for MRI
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular
CT/MRI
The LI-RADS lexicon divides imaging features into:
1. Major features (LR-5 categorization) include
• nonrim APHE
• nonperipheral “washout” appearanceportal venous phase with gadoxetate
disodium or gadobenate dimeglumine
• enhancing “capsule” appearance
• size and threshold growth at least 50% in 6 month or less
2. LR-M features
include a targetoid or nontargetoid mass with one or more of the following findings:
infiltrative appearance, marked diffusion restriction, necrosis, or other features
suggestive of non-HCC malignancy
3. Ancillary features
Improve the accuracy of categorization and lesion detection or diagnostic
confidence. Detailed
discussion of ancillary features can be found on the ACR website
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Journal of Radiology.289(3):1-15
CT/MRI Categories
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
CT/MRI Categories
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
CT/MRI Categories
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
CT/MRI
Image Interpretation
Tumor in vein is often associated with HCCit can occur in the
setting of non-HCC malignancy.
Malignant lesions confirmed with biopsy (eg, HCC, iCCA)
Benign lesions of nonhepatocellular origin (eg, hemangioma) do
not require LI-RADS categorization unless:
1. There is discordance between imaging and pathology
findings
2. There is some other doubt about the diagnosis.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Contrast-enhanced US
• Performed with intravenous injection of a microbubble contrast
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Contrast-enhanced US
• Microbubbles = pure blood pool agents, confined within the blood
space, do not leak through endothelial fenestrations into the tumor
or parenchymal interstitium --> their distribution on postarterial
phase images reflects the relative blood volume.
• HCC --> have only slightly lower blood volume than the liver -->
exhibit mild and late-onset washout
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Treatment Response
• The LI-RADS treatment response algorithm also applies
to observations at the surgical margin after resection of HCC
• does not apply to systemic chemo-, targeted, or
immunologic therapies, nor does it apply to treatment
response using contrastenhanced US
• In patients who underwent both systemic therapy and local-
regional treatment, the LI-RADS treatment response
algorithm can be applied at the discretion of the interpreting
radiologist.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Treatment Response
Analogous in concept to the diagnostic algorithms,
LIRADS treatment response category codes reflect the
relative probability of tumor viability after local-regional
therapy to guide management decisions.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular
Carcinoma.Journal of Radiology.289(3):1-15
Reporting
• Surveillance reports should include LI-RADS US category
and visualization scores
• Diagnostic and staging reports should describe
individual observations, including their size, major features
(and ancillary features if used for category adjustment), and
final diagnostic category.
• Treatment response reports should assign a LI-RADS
treatment response category, include the pretreatment
LIRADS category (or histologic diagnosis, if known), and
provide a measure of viable or equivocally viable tumor.
Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
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Management
• Strongly influenced by the imaging observation with the
highest risk of malignancy
• Although radiologists provide an initial estimate of the
relative likelihood of HCC or viable tumor, the estimate may
be refined by clinical history, biomarker levels, and other
factors.
• Decisions between management options do not follow solely
from the estimated probability of HCC. Thus, management
decisions should be determined with a multidisciplinary
approach.
Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular
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Carcinoma.Journal of Radiology.289(3):1-15
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Biopsy Considerations
• Biopsy may assist management decisions in patients
with LR-3, LR-4, or LR-M observations
• LR-5 observations do not require pathologic proof of
diagnosis.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Biopsy Considerations
Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
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Journal of Radiology.289(3):1-15
LI-RADS: Emerging Evidence
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Gaps and Future Directions
• Studies are needed to define the optimal work-up strategy
of indeterminate (LR3) and suspicious (LR-4) observations.
• Although these lesions carry the risk of being or progressing
to HCC, it is unclear how long they require monitoring with
diagnostic imaging, if they should undergo biopsy, and
whether patients can ever return to the original surveillance
schedule.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma.
Conclusion
• LI-RADS provides algorithm for diagnostic criteria,
surveillance, treatment response, and contrast
enhanced US-based diagnosis
• All LI-RADS algorithms are built on the foundation of
standardized lexicon, technique, management, and
reporting guidelines.
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Chernyak, V., dkk.2018. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular
THANK YOU
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