THE LIVER IMAGING-REPORTING

AND DATA SYSTEM (LI-RADS)

Liver Cancer

3rd leading cause of cancer-related mortality

worldwide
Male : Female = 2.4 : 1
HCC is the predominant primary liver cancer
Etiology : hepatitis C virus, obesity & diabetes
(nonalcoholic fatty liver), liver cirrhosis, alcoholic
LI-RADS
For CT & MRI imaging with extracellular contrast
agents of the liver in patient undergoing HCC
LI-RADS categories are used to classify as either a
definite HCC (LR-5) or definitely benign (LR-1)
LI-RADS use term observation instead of lesion
because some observation may actually correspond to
areas that are not histologically distinct from the
adjacent parenchyma, such as area of perfusion
alteration
Current version of LI-RADS applies to untreated
observations only and should be used only for patient
at risk for HCC
LI-RADS
5 major features by LI-RADS
Masslike configuration
Arterial phase hyperenhancement
Portal venous phase or later phase hypoenhancement
Increase of > 10 mm in diameter within 1 year
Tumor within the lumen of a vein
Masslike configuration
Features suggesting mass as describe by LI-RADS:
Ring enhancement during portal venous phase or later
(equivalent to a capsule or pseudocapsule)
Visibility on image obtained prior to the administration of
contrast material and on diffusion-, T2-, or T2*-WI
Discrete margins
Rounded shape
Focal deformity of the liver contour
Displacement of intraparenchymal structures
Arterial Phase Hyperenhancement
Most important feature for HCC
All or part observation must demonstrate
hyperenhancement than the surrounding liver
parenchyma during the arterial phase
Neoangiogenesis stepwise process of carcinogenesis
& dominant blood supply in HCC lesion
Many factor, including portal hypertension, may
cause delay organ enhancement
In some patient, hyperenhancement may be more
evident on portal venous phase than on arterial phase
Portal Venous Phase / Later Phase Hypoenhancement
Strong predictor of HCC washout
It because of :
Early venous drainage
Decreased portal venous supply to HCC that accompanies
neoangiogenesis
Greater enhancement of surroundng liver parenchyma than of
the HCC of portal phase
In case of arterial phase hypoenhancement
Attenuation / signal intensity must be unequivocally less than
during an earlier phase
Ensure the observation demonstrate unequivocal enhancement
compared with the precontrast phase
Fibrotic tissue typically demonstrate delayed enhancement
mimic a delayed enhancement capsule or pseudocapsule
Increase > 10 mm in Diameter Within 1 Year
Important at follow-up imaging for the
characterization of initially small (< 2 cm) lesion
lacking the classic imaging features of HCC
Interval growth is highly predictive of HCC
Portal Venous Phase / Later Phase Hypoenhancement
Strong predictor of HCC washout
It because of :
Early venous drainage
Decreased portal venous supply to HCC that accompanies
neoangiogenesis
Greater enhancement of surroundng liver parenchyma than of
the HCC of portal phase
In case of arterial phase hypoenhancement
Attenuation / signal intensity must be unequivocally less than
during an earlier phase
Ensure the observation demonstrate unequivocal enhancement
compared with the precontrast phase
Fibrotic tissue typically demonstrate delayed enhancement
mimic a delayed enhancement capsule or pseudocapsule