Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Abdominal Radiology
Published in: Abdominal Radiology 1/2018

01-01-2018 | Invited article

LI-RADS® ancillary features on CT and MRI

Authors: Victoria Chernyak, An Tang, Milana Flusberg, Demetri Papadatos, Bijan Bijan, Yuko Kono, Cynthia Santillan

Published in: Abdominal Radiology | Issue 1/2018

Login to get access

Abstract

The Liver Imaging Reporting and Data System (LI-RADS) uses an algorithm to assign categories that reflect the probability of hepatocellular carcinoma (HCC), non-HCC malignancy, or benignity. Unlike other imaging algorithms, LI-RADS utilizes ancillary features (AFs) to refine the final category. AFs in LI-RADS v2017 are divided into those favoring malignancy in general, those favoring HCC specifically, and those favoring benignity. Additionally, LI-RADS v2017 provides new rules regarding application of AFs. The purpose of this review is to discuss ancillary features included in LI-RADS v2017, the rationale for their use, potential pitfalls encountered in their interpretation, and tips on their application.
Literature
1.
Wald C, Russo MW, Heimbach JK, et al. (2013) New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 266(2):376–382CrossRefPubMed
2.
3.
EASL-EORTC clinical practice guidelines (2012) management of hepatocellular carcinoma. J Hepatol 56(4):908–943CrossRef
4.
Omata M, Lesmana LA, Tateishi R, et al. (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4(2):439–474CrossRefPubMedPubMedCentral
5.
Kudo M, Matsui O, Izumi N, et al. (2014) JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan. Liver Cancer 3(3–4):458–468CrossRefPubMedPubMedCentral
6.
Wilson; Kono Y. LI-RADS algorithm: CEUS. Abdom Radiol 2017.
7.
Darnell A, Forner A, Rimola J, et al. (2015) Liver imaging reporting and data system with MR imaging: evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275(3):698–707CrossRefPubMed
8.
Okada S, Okazaki N, Nose H, et al. (1993) Follow-up examination schedule of postoperative HCC patients based on tumor volume doubling time. Hepato-gastroenterology 40(4):311–315PubMed
9.
Kubota K, Ina H, Okada Y, Irie T (2003) Growth rate of primary single hepatocellular carcinoma: determining optimal screening interval with contrast enhanced computed tomography. Dig Dis Sci 48(3):581–586CrossRefPubMed
10.
Furlan A, Marin D, Agnello F, et al. (2012) Hepatocellular carcinoma presenting at contrast-enhanced multi-detector-row computed tomography or gadolinium-enhanced magnetic resonance imaging as a small (</ = 2 cm), indeterminate nodule: growth rate and optimal interval time for imaging follow-up. J Comp Assist Tomogr 36(1):20–25CrossRef
11.
Taouli B, Goh JS, Lu Y, et al. (2005) Growth rate of hepatocellular carcinoma: evaluation with serial computed tomography or magnetic resonance imaging. J Comp Assist Tomogr 29(4):425–429CrossRef
12.
Park Y, Choi D, Lim HK, et al. (2008) Growth rate of new hepatocellular carcinoma after percutaneous radiofrequency ablation: evaluation with multiphase CT. AJR Am J Roentgenol 191(1):215–220CrossRefPubMed
13.
Miyayama S, Yamashiro M, Okuda M, et al. (2011) Detection of corona enhancement of hypervascular hepatocellular carcinoma by C-arm dual-phase cone-beam CT during hepatic arteriography. Cardiovasc Interv Radiol 34(1):81–86CrossRef
14.
Ueda K, Matsui O, Kawamori Y, et al. (1998) Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology 206(1):161–166CrossRefPubMed
15.
Terayama N, Matsui O, Ueda K, et al. (2002) Peritumoral rim enhancement of liver metastasis: hemodynamics observed on single-level dynamic CT during hepatic arteriography and histopathologic correlation. J Comput Assist Tomogr 26(6):975–980CrossRefPubMed
16.
Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y (2009) Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography–radiologic–pathologic correlation. Radiology 252(2):605–614CrossRefPubMed
17.
Santillan C FK, Kono Y, Chernyak V. LI-RADS major features: CT, MRI with ECA, and MRI with HBA. Abdom Radiol 2017.
18.
Bruegel M, Holzapfel K, Gaa J, et al. (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18(3):477–485CrossRefPubMed
19.
Taouli B, Vilgrain V, Dumont E, et al. (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226(1):71–78CrossRefPubMed
20.
Le Moigne F, Durieux M, Bancel B, et al. (2012) Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver. Magn Reson Imaging 30(5):656–665CrossRefPubMed
21.
Xu PJ, Yan FH, Wang JH, et al. (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34(4):506–512CrossRefPubMed
22.
Kwon HJ, Byun JH, Kim JY, et al. (2015) Differentiation of small (</ = 2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images. Abdom Imaging 40(1):64–75CrossRefPubMed
23.
Nasu K, Kuroki Y, Tsukamoto T, et al. (2009) Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. AJR Am J Roentgenol 193(2):438–444CrossRefPubMed
24.
Hwang J, Kim YK, Park MJ, et al. (2012) Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI. J Magn Reson Imaging 36(4):881–889CrossRefPubMed
25.
Kim YK, Lee WJ, Park MJ, et al. (2012) Hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis: potential of DW imaging in predicting progression to hypervascular HCC. Radiology 265(1):104–114CrossRefPubMed
26.
27.
Park HJ, Kim YK, Park MJ, Lee WJ (2013) Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma. Abdom Imaging. 38(4):793–801CrossRefPubMed
28.
Di Martino M, Anzidei M, Zaccagna F, et al. (2016) Qualitative analysis of small (</ = 2 cm) regenerative nodules, dysplastic nodules and well-differentiated HCCs with gadoxetic acid MRI. BMC Med Imaging 16(1):62CrossRefPubMedPubMedCentral
29.
Li CS, Chen RC, Lii JM, et al. (2006) Magnetic resonance imaging appearance of well-differentiated hepatocellular carcinoma. J Comput Assist Tomogr 30(4):597–603CrossRefPubMed
30.
Rhee H, Kim MJ, Park YN, Choi JS, Kim KS (2012) Gadoxetic acid-enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria. J Magn Reson Imaging 35(2):393–398CrossRefPubMed
31.
Kelekis NL, Semelka RC, Worawattanakul S, et al. (1998) Hepatocellular carcinoma in North America: a multiinstitutional study of appearance on T1-weighted, T2-weighted, and serial gadolinium-enhanced gradient-echo images. AJR Am J Roentgenol 170(4):1005–1013CrossRefPubMed
32.
Enomoto S, Tamai H, Shingaki N, et al. (2011) Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis. Hepatol Int 5(2):730–737CrossRefPubMedPubMedCentral
33.
van den Bos IC, Hussain SM, Dwarkasing RS, et al. (2007) MR imaging of hepatocellular carcinoma: relationship between lesion size and imaging findings, including signal intensity and dynamic enhancement patterns. J Magn Reson Imaging 26(6):1548–1555CrossRefPubMed
34.
Ebara M, Fukuda H, Kojima Y, et al. (1999) Small hepatocellular carcinoma: relationship of signal intensity to histopathologic findings and metal content of the tumor and surrounding hepatic parenchyma. Radiology 210(1):81–88CrossRefPubMed
35.
Kamura T, Kimura M, Sakai K, et al. (2002) Small hypervascular hepatocellular carcinoma versus hypervascular pseudolesions: differential diagnosis on MRI. Abdom Imaging. 27(3):315–324CrossRefPubMed
36.
Hyodo T, Murakami T, Imai Y, et al. (2013) Hypovascular nodules in patients with chronic liver disease: risk factors for development of hypervascular hepatocellular carcinoma. Radiology 266(2):480–490CrossRefPubMed
37.
Jha RC, Zanello PA, Nguyen XM, et al. (2014) Small hepatocellular carcinoma: MRI findings for predicting tumor growth rates. Acad Radiol 21(11):1455–1464CrossRefPubMed
38.
Rosenkrantz AB, Lee L, Matza BW, Kim S (2012) Infiltrative hepatocellular carcinoma: comparison of MRI sequences for lesion conspicuity. Clin Radiol 67(12):e105–e111CrossRefPubMed
39.
Cruite I, Schroeder M, Merkle EM, Sirlin CB (2010) Gadoxetate disodium-enhanced MRI of the liver: part 2, protocol optimization and lesion appearance in the cirrhotic liver. AJR Am J Roentgenol 195(1):29–41CrossRefPubMed
40.
Lee MH, Kim SH, Park MJ, Park CK, Rhim H (2011) Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol 197(5):W868–W875CrossRefPubMed
41.
Choi SH, Byun JH, Lim YS, et al. (2016) Diagnostic criteria for hepatocellular carcinoma 3 cm with hepatocyte-specific contrast-enhanced magnetic resonance imaging. J Hepatol 64(5):1099–1107CrossRefPubMed
42.
Bartolozzi C, Battaglia V, Bargellini I, et al. (2013) Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging 38(2):290–296CrossRefPubMed
43.
Cortis K, Liotta R, Miraglia R, et al. (2016) Incorporating the hepatobiliary phase of gadobenate dimeglumine-enhanced MRI in the diagnosis of hepatocellular carcinoma: increasing the sensitivity without compromising specificity. Acta Radiol 57(8):923–931CrossRefPubMed
44.
Orlacchio A, Chegai F, Fabiano S, et al. (2016) Role of MRI with hepatospecific contrast agent in the identification and characterization of focal liver lesions: pathological correlation in explanted livers. La Radiol Med 121(7):588–596CrossRef
45.
Hope TA, Fowler KJ, Sirlin CB, et al. (2015) Hepatobiliary agents and their role in LI-RADS. Abdom Imaging 40(3):613–625CrossRefPubMed
46.
An C, Rhee H, Han K, et al. (2016) Added value of smooth hypointense rim in the hepatobiliary phase of gadoxetic acid-enhanced MRI in identifying tumour capsule and diagnosing hepatocellular carcinoma. Eur Radiol 27:2610–2618CrossRefPubMed
47.
Dioguardi Burgio M, Picone D, Cabibbo G, et al. (2016) MR-imaging features of hepatocellular carcinoma capsule appearance in cirrhotic liver: comparison of gadoxetic acid and gadobenate dimeglumine. Abdom Radiol 41:1546–1554CrossRef
48.
Suh YJ, Kim MJ, Choi JY, et al. (2011) Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol 197(1):W44–W52CrossRefPubMed
49.
Chong YS, Kim YK, Lee MW, et al. (2012) Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol 67(8):766–773CrossRefPubMed
50.
Kim R, Lee JM, Shin CI, et al. (2016) Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 26(6):1808–1817CrossRefPubMed
51.
Stevens WR, Gulino SP, Batts KP, Stephens DH, Johnson CD (1996) Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance. J Comput Assist Tomogr 20(3):337–342CrossRefPubMed
52.
Choi BI, Takayasu K, Han MC (1993) Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. AJR Am J Roentgenol 160(6):1177–1187CrossRefPubMed
53.
Yoshida T, Matsue H, Okazaki N, Yoshino M (1987) Ultrasonographic differentiation of hepatocellular carcinoma from metastatic liver cancer. J Clin Ultrasound 15(7):431–437CrossRefPubMed
54.
Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M (2000) Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol 33(2):282–289CrossRefPubMed
55.
Park HJ, Jang KM, Kang TW, et al. (2016) Identification of imaging predictors discriminating different primary liver tumours in patients with chronic liver disease on gadoxetic acid-enhanced MRI: a classification tree analysis. Eur Radiol 26(9):3102–3111CrossRefPubMed
56.
Sheng RF, Zeng MS, Ji Y, et al. (2015) MR features of small hepatocellular carcinoma in normal, fibrotic, and cirrhotic livers: a comparative study. Abdom Imaging 40(8):3062–3069CrossRefPubMed
57.
Ebara M, Hatano R, Fukuda H, et al. (1998) Natural course of small hepatocellular carcinoma with underlying cirrhosis. A study of 30 patients. Hepato-gastroenterology 45(Suppl 3):1214–1220PubMed
58.
Yamagata M, Masaki T, Okudaira T, et al. (1999) Small hyperechoic nodules in chronic liver diseases include hepatocellular carcinomas with low cyclin D1 and Ki-67 expression. Hepatology 29(6):1722–1729CrossRefPubMed
59.
Huz JI, Melis M, Sarpel U (2012) Spontaneous regression of hepatocellular carcinoma is most often associated with tumour hypoxia or a systemic inflammatory response. HPB 14(8):500–505CrossRefPubMedPubMedCentral
60.
Tamada T, Ito K, Yamamoto A, et al. (2011) Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium. AJR Am J Roentgenol 196(4):824–830CrossRefPubMed
61.
Kim B, Byun JH, Kim HJ, et al. (2016) Enhancement patterns and pseudo-washout of hepatic haemangiomas on gadoxetate disodium-enhanced liver MRI. Eur Radiol 26(1):191–198CrossRefPubMed
62.
Brancatelli G, Federle MP, Blachar A, Grazioli L (2001) Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 219(1):69–74CrossRefPubMed
63.
Krinsky GA, Lee VS, Nguyen MT, et al. (2000) Siderotic nodules at MR imaging: regenerative or dysplastic? J Comput Assist Tomogr 24(5):773–776CrossRefPubMed
64.
Krinsky GA, Zivin SB, Thorner KM, et al. (2002) Low-grade siderotic dysplastic nodules: determination of premalignant lesions on the basis of vasculature phenotype. Acad Radiol 9(3):336–341CrossRefPubMed
65.
66.
Krinsky GA, Lee VS, Nguyen MT, et al. (2001) Siderotic nodules in the cirrhotic liver at MR imaging with explant correlation: no increased frequency of dysplastic nodules and hepatocellular carcinoma. Radiology 218(1):47–53CrossRefPubMed
67.
Ringe KI, Husarik DB, Sirlin CB, Merkle EM (2010) Gadoxetate disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion appearance in the noncirrhotic liver. AJR Am J Roentgenol 195(1):13–28CrossRefPubMed
68.
Ahn SJ, Kim MJ, Hong HS, Kim KA, Song HT (2011) Distinguishing hemangiomas from malignant solid hepatic lesions: a comparison of heavily T2-weighted images obtained before and after administration of gadoxetic acid. J Magn Resone Imaging 34(2):310–317CrossRef
69.
70.
Silva AC, Evans JM, McCullough AE, et al. (2009) MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 29(2):385–402CrossRefPubMed
71.
Ahn JH, Yu JS, Hwang SH, et al. (2010) Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol 20(2):385–394CrossRefPubMed
72.
Kim JI, Lee JM, Choi JY, et al. (2008) The value of gadobenate dimeglumine-enhanced delayed phase MR imaging for characterization of hepatocellular nodules in the cirrhotic liver. Investig Radiol. 43(3):202–210CrossRef
Metadata
Title
LI-RADS® ancillary features on CT and MRI
Authors
Victoria Chernyak
An Tang
Milana Flusberg
Demetri Papadatos
Bijan Bijan
Yuko Kono
Cynthia Santillan
Publication date
01-01-2018
Publisher
Springer US
Published in
Abdominal Radiology / Issue 1/2018
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-017-1220-6

Other articles of this Issue 1/2018

Abdominal Radiology 1/2018 Go to the issue

OriginalPaper

CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI

Invited article

Cirrhosis and LI-RADS

OriginalPaper

US LI-RADS: ultrasound liver imaging reporting and data system for screening and surveillance of hepatocellular carcinoma

Invited article

Liver transplantation for hepatocellular carcinoma

Invited article

Letter to the editor response

Letter to the Editor

Letter to the editor
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits