1. CT-SCAN & MRI LIRADS 2018
Dr. NGUYỄN HỒ TRÚC LINH - MRI

2. CONTENTS: What’s LIRADS?1
What’s LIRADS? 2
Which cases is LIRADS Applied and not applied for? 3
LIRADS ’ diagnostic categories 4
Treatment and Prognosis through LIRADS

3. 1. WHAT IS LIRADS? Liver Imaging Reporting and Data System
A classification system for imaging findings in liver lesions.
The LI-RADS score for a liver lesion is an indication of its relative risk for hepatocellular carcinoma (HCC).
Standardization also helps interpret therapeutic performance.
The scoring system also potentially helps non-hepatologists interpret the potential suspiciousness of liver lesions in their patients.
1. WHAT IS LIRADS?

4. 2. ✓ APPLY
✘ DO NOT APPLY
In patients at high risk for HCC,namely those with:
• Cirrhosis
• Chronic hepatitis B viral infection
• Current or prior HCC
In patients:
• Without the above risk factors
• < 18 years old
• With cirrhosis due to:
1. Congenital hepatic fibrosis
2. A vascular disorder
For multiphase exams performed with:
• CT or MRI with extracellular contrast agents (ECA) OR
• MRI with hepatobiliary contrast agents (HBA)
Do not assign LI-RADS categories for observations:
• That are path-proven malignancies OR
• That are path-proven benign lesions of non-hepatocellular origin such as hemangiomas

6. Imaging features diagnostic of a benign entity
LR-1 (100% BENIGN):
Imaging features diagnostic of a benign entity
Cyst
Hemangioma
Vascular anomaly
Perfusion alteration
Hypertrophic pseudomass
Confluent hepatic fibrosis
Focal scar
Definite disappearance at follow up without treatment is also indicative of LR-1

7. NO: APHE, Washout, Capsule, Growth
LR-2 (PROBABLY BENIGN):
Similar to LR-1.
A solid <20mm nodule, without malignant / HCC / LR-M imaging features.
T1 Hyperintense
T2 Hypointense
Siderotic
HBP Hyperintense
NO: APHE, Washout, Capsule, Growth

8. Arterial phase Hyperenhancement (APHE) Nonperipheral “Washout”
LR-3 ; LR-4 ; LR-5: BASED ON FEATURES:
Arterial phase Hyperenhancement (APHE)
Enhancing “Capsule”
Nonperipheral “Washout”
Threshold Growth
Size increase of a mass by ≥50% in ≤6 months
No APHE
Nonrim APHE

9. LR-3 ; LR-4 ; LR-5

10. LR-NC (LR-Non Categorizable):
SPECIAL CATEGORIES:
LR-NC (LR-Non Categorizable):
For lesions in which the technical quality of the MRI does not allow evaluation of the major features.

11. LR-M:
For liver lesions that are probably or definitely malignant, but not an appearance compatible with HCC.
SPECIAL CATEGORIES:

12. Malignancies other than HCC can invade the portal venous system.
LR-TIV:
For unequivocal enhancing soft tissue invading the portal vein, regardless of whether an underlying parenchymal mass is visible.
This is important to report since it is a contraindication to liver transplantation.
Malignancies other than HCC can invade the portal venous system.
SPECIAL CATEGORIES:
SPECIAL CATEGORIES:
LR-TIV:
For unequivocal enhancing soft tissue invading the portal vein, regardless of whether an underlying parenchymal mass is visible.
This is important to report since it is a contraindication to liver transplantation.
Malignancies other than HCC can invade the portal venous system.

13. CASES

14. 1ST CASE:
A 65 y.o female patient, with a medical history of Cirrhosis.
AFP: 1194,8 ng/ml; L3: 8,7%; DCP: 5801 mAU/mL.
CT-Scan: a 50 mm lesion in the right hepatic lobe.

15. ARTERIAL PHASE
PRE-CONTRAST
VENOUS PHASE
DELAYED PHASE

17. 2ND CASE:
A 70 y.o male patient, with Chronic hepatitis B virus infection.
AFP: 9,6 ng/ml; L3: 4,5%; DCP: 24 mAU/mL.
T2WI: a 14 mm lesion in the right hepatic lobe

18. PRIMOVIST
PRE-CONTRAST
ARTERIAL PHASE
VENOUS PHASE
Hepatobiliary PHASE

20. 3RD CASE:
A 69 y.o male patient, with Chronic hepatitis infection.
T2WI: a 44x33 mm lesion in the segment IV.

21. ARTERIAL PHASE
PRE-CONTRAST
VENOUS PHASE
Hepatobiliary PHASE
PRIMOVIST

23. 4TH CASE:
A 56 y.o female patient, with a medical history of Chronic hepatitis B virus infection.
T2WI: a 18 mm lesion in the right hepatic lobe.

24. ARTERIAL PHASE
PRE-CONTRAST
VENOUS PHASE
DELAYED PHASE
GADOVIST

25. NO: APHE, Washout, Capsule, Growth
LR-2 (PROBABLY BENIGN)
Similar to LR-1.
A solid <20mm nodule, without malignant / HCC / LR-M imaging features.
T1 Hyperintense
T2 Hypointense
Siderotic
HBP Hyperintense
NO: APHE, Washout, Capsule, Growth

26. 5TH CASE:
A 49 y.o male patient, with Chronic hepatitis infection
CT-Scan: a 37 mm lesion in the right hepatic lobe.

27. ARTERIAL PHASE
PRE-CONTRAST
VENOUS PHASE
DELAYED PHASE

28. 4. Treatment and Prognosis
Continued routine surveillance
LR1
Continued routine surveillance, consider repeat diagnostic imaging in 6 months or less
LR2
Repeat or alternative diagnostic imaging in 3-6 months
LR3
Multidisciplinary team discussion for tailored workup, may include biopsy
LR4
Diagnosis confirmed - plan treatment
LR5
Repeat or alternative diagnostic imaging in three months or less
LR-NC

29. References: References:

30. THANKS FOR LISTENING!