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The first version of LI-RADS was released in 2011 by the ACR (American
College of Radiology)
The most recent update in 2018, LI-RADS was integrated into AASLD
(American Association for the Study of Liver Diseases) clinical practice
guidance.
LI-RADS version 2018 updated the criteria for small (size range,10–19
mm) LR-5 lesions and simplified the definition for threshold growth
US LI-RADS Surveilance
Contrast material-
Diagnosis
enhance US LI-RADS
Hyperechoic observation
is identified that follow up
in 3-6 month to ensure
stability
Solid hypoechoic >10mm in left
New thrombus in vein Parenchymal distortion
lobe of the liver
CT/MRI
For Diagnosis
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.
Contrast-enhanced US
• performed with intravenous injection of a microbubble contrast
• Real-time imaging is performed continuously for the 1st (arterial phase). This is
followed by intermittent scanning every 30–60 seconds for up to about 5 minutes
to evaluate washout.
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
• ICCAs, non-HCC malignancies --> lower blood volume --> early washout