CT/MRI LI-RADS v2018 vs. CEUS LI-RADS v2017-Can Things Be Put Together?

Area of Science:

• Radiology and Medical Imaging
• Hepatology
• Oncology

Background:

• Liver Imaging Reporting and Data System (LI-RADS) provides standardized criteria for liver nodule classification in cirrhotic patients.
• Separate LI-RADS core documents exist for Contrast-Enhanced Ultrasound (CEUS) and CT/MRI, both utilizing major and ancillary diagnostic criteria.
• Accurate classification of liver nodules is crucial for patient management and treatment decisions in cirrhotic livers.

Purpose of the Study:

• To conduct an exhaustive comparison of LI-RADS documents for CEUS and CT/MRI.
• To focus on the differences, complementarity, and added value of these imaging techniques in classifying liver nodules.
• To provide recommendations for physicians on when to combine imaging techniques for optimal liver nodule management.

Main Methods:

• Comparative analysis of LI-RADS major and ancillary diagnostic criteria for CEUS and CT/MRI.
• Review of literature to present sensitivity and specificity of major diagnostic criteria for each technique.
• Evaluation of the impact of ancillary features on LI-RADS scoring across different imaging modalities.

Main Results:

• Differences exist in major diagnostic criteria assessment between CEUS and CT/MRI, offering opportunities for improved classification.
• Ancillary features can modify LI-RADS scores (up to LI-RADS 4), with MRI offering more ancillary features than CEUS.
• CEUS has fewer ancillary features compared to other imaging techniques, impacting its role in nuanced classifications.

Conclusions:

• Exploiting the differences in major diagnostic features between CEUS and CT/MRI can enhance liver nodule classification and clinical management.
• MRI provides a broader range of ancillary features for LI-RADS assessment compared to CEUS.
• Strategic integration of different imaging techniques is recommended for comprehensive management of liver nodules in cirrhotic patients.