Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI

Figures & data

Figure 1. LI-RADS 5: definitely hepatocellular carcinoma.

Axial T1-weighted fat-saturated magnetic resonance images obtained precontrast (A) and after injection of an extracellular gadolinium-based contrast agent, in the hepatic arterial (B), portal venous (C) and 5-min delayed (D) phases show a 2.5 cm mass in segment 2 (arrow) of the liver in a 63-year-old woman with cirrhosis due to hepatitis C viral infection. Relative to liver, the mass is mildly hyperintense precontrast, hyperenhances in the arterial phase, and hypoenhances in the portal venous and delayed phases (washout appearances). A peripheral rim of enhancement is evident in the portal venous and delayed phases (capsule appearance). In a patient with cirrhosis or other risk factors for HCC, a mass with these imaging features is categorized LI-RADS 5 (100% certainty observation is HCC).

HCC: Hepatocellular carcinoma; LI-RADS: Liver Imaging Reporting and Data System.

Table 1. Summary of Liver Imaging and Reporting Data system (version 2013) category codes.

LI-RADS category code	Concept and definition
LR1: definitely benign	Concept: 100% certainty that the observation is benignDefinition: observation with imaging features diagnostic of a benign entity or definite disappearance in absence of treatment at follow up
LR2: probably benign	Concept: high probability observation is benignDefinition: observation with imaging features suggestive but not diagnostic of benign entity
LR3: intermediate probability for HCC	Concept: both HCC and benign entity have moderate probabilityDefinition: observation that does not meet criteria for other LI-RADS categories
LR4: probably HCC	Concept: high probability observation is HCC but there is not 100% certaintyDefinition: observation with imaging features suggestive but not diagnostic of HCC
LR5: definitely HCC	Concept: 100% certainty observation is HCCDefinition: observation with imaging features diagnostic of HCC or proven to be HCC at histology
LR5V: definitely HCC with tumor in vein	Concept: 100% certainty that observation is HCC invading veinDefinition: observation with imaging features diagnostic of HCC invading vein
LR5 treated: treated HCC	Concept: a locoregionally treated HCCDefinition: LR5A or 5B observation or biopsy-proven HCC lesion that has undergone locoregional treatment
OM	Concept: high probability that observation is a malignancy other than HCCDefinition: observation with features suggestive of non-HCC malignancy

Shown are concepts and definitions for LI-RADS version 2013 category codes [103].

HCC: Hepatocellular carcinoma; LI-RADS: Liver Imaging Reporting and Data System; OM: Other malignancy.

Activity Evaluation: Where 1 is strongly disagree and 5 is strongly agree

	1	2	3	4	5
1. The activity supported the learning objectives.
2. The material was organized clearly for learning to occur.
3. The content learned from this activity will impact my practice.
4. The activity was presented objectively and free of commercial bias.

American College of Radiology. Liver Imaging Reporting and Data System version 2013.1. www.acr.org/Quality-Safety/Resources/LIRADS/.

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