CEUS LI-RADS

Contrast-enhanced ultrasound LI-RADS

Categorization of liver observations on contrast-enhanced ultrasound in patients at risk for HCC.

vigenteAmerican College of Radiologyv20172017US

LR-1Definitely benign LR-2Probably benign LR-3Intermediate probability LR-4Probably HCC LR-5Definitely HCC LR-MProbably or definitely malignant, not HCC specific LR-TIVTumor in vein

Aplicar o CEUS LI-RADS a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

Categorias

Reescritas a partir da fonte e citadas

LR-1

1 de 7

Definitely benign

Definitely benign at CEUS. Typical entities: simple cyst (no enhancement in any vascular phase), hemangioma (peripheral nodular/globular arterial enhancement with progressive centripetal fill-in), and focal fat deposition or sparing (isoenhancing to liver in all phases). No diagnostic uncertainty.

CondutaReturn to routine surveillance, typically CEUS or other surveillance imaging in about 6 months.

RiscoDefinitely benign; effectively 0% probability of malignancy.

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 (Terzi et al., 'CEUS LI-RADS: a pictorial review', Insights Imaging 2019), category and management sections for LR-1.

LR-2

2 de 7

Probably benign

Probably benign at CEUS. Examples: solid nodule under 10 mm that is isoenhancing to liver in all phases; non-mass-like isoenhancing observation 10 mm or larger; atypically located focal fat deposition or sparing. Causes essentially no diagnostic concern.

CondutaReturn to routine surveillance, typically repeat surveillance imaging in about 6 months.

RiscoProbably benign; very low probability of malignancy.

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 category and management sections for LR-2.

LR-3

3 de 7

Intermediate probability

Intermediate probability of malignancy (similar chance of being benign vs HCC). Includes any nodule lacking both APHE and washout regardless of size; a nodule under 2 cm without APHE that shows late (>=60 s) and mild washout; or APHE without washout when the nodule is under 10 mm.

CondutaRepeat CEUS or alternative contrast imaging (CT or MRI) within about 6 months for re-evaluation.

RiscoIntermediate probability of malignancy.

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 category and management sections for LR-3.

LR-4

4 de 7

Probably HCC

Probably HCC. Per CEUS LI-RADS v2017: nodule 2 cm or larger without APHE but with late (>=60 s) and mild washout; APHE without washout when the nodule is 10 mm or larger; or APHE with late and mild washout when the nodule is under 10 mm. Distinguished from LR-5 chiefly by size/washout combination (no washout, or sub-10 mm).

CondutaMultidisciplinary discussion for consensus management; if neither biopsy nor treatment is planned, repeat or alternative diagnostic imaging in about 3 months.

RiscoHigh but not definitive probability of HCC.

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 category and management sections for LR-4; corroborated by PMC9929373 (Jiang et al. 2023) Discussion (LR-4 = same conditions as LR-5 but without washout).

LR-5

5 de 7

Definitely HCC

Definitely HCC. Nodule 10 mm or larger showing non-rim, non-peripheral-globular arterial-phase hyperenhancement (APHE) combined with LATE (onset >=60 s) and MILD washout. Late/mild washout is the key discriminator from LR-M (which shows early or marked washout).

CondutaTreat as HCC; multidisciplinary discussion for consensus management. May justify treatment without biopsy in a suitable lesion.

RiscoDefinitely HCC. In a CEUS LR-5 meta-analysis, pooled specificity was about 0.93 and sensitivity about 0.71 for HCC.

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 category and management sections for LR-5; pooled performance from PMC9929373 (Jiang et al., Quant Imaging Med Surg 2023) Results/Abstract.

LR-M

6 de 7

Probably or definitely malignant, not HCC specific

Probably or definitely malignant but not specific for HCC (e.g. intrahepatic cholangiocarcinoma, metastasis). Defined by any of: rim (ring-like) APHE; EARLY washout (onset <60 s); or MARKED washout (near-complete loss of enhancement within ~2 min). Early and/or marked washout separates LR-M from LR-5.

CondutaMultidisciplinary discussion for consensus management; may include alternative or repeat imaging, biopsy, or treatment.

RiscoProbable or definite malignancy that is not HCC-specific.

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 category and management sections for LR-M; corroborated by PMC9929373 Introduction (LR-M = probable malignancy but not HCC-specific).

LR-TIV

7 de 7

Tumor in vein

Definite tumor in vein: unequivocal enhancing soft tissue within the lumen of a portal and/or hepatic vein, identified independently of any coexisting parenchymal mass. Early arterial arrival of enhancement (about the same time as the hepatic artery) favors tumor over bland thrombus.

CondutaMultidisciplinary discussion for consensus management; biopsy or biomarker correlation may be used to establish etiology.

RiscoIndicates malignant vascular invasion; most are HCC, some intrahepatic cholangiocarcinoma or combined HCC-CCA. Etiology and prognosis track the associated parenchymal lesion (LR-4/5 vs LR-M).

verificadoCEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data SystemPMC7000618 LR-TIV section ('enhancing tissue within a vein... early arrival time favors tumor in vein').

Lógica de decisão estruturada

{
  "categories": [
    "LR-1",
    "LR-2",
    "LR-3",
    "LR-4",
    "LR-5",
    "LR-M",
    "LR-TIV"
  ]
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.