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Liver Imaging Reporting and Data System Contrast-Enhanced US Nonradiation Treatment Response Assessment Version 2024.

Andrej Lyshchik1, David T Fetzer1, Yuko Kono1

  • 1From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.); Departments of Medicine and Radiology, University of California, San Diego, San Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine, Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center, Department of Radiology, LMU University Hospital, Ludwig Maximilian University of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (F.P.); and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (F.P.).

Radiology
|May 28, 2024
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Summary

The updated LI-RADS CEUS Nonradiation TRA v2024 standardizes contrast-enhanced ultrasound for assessing hepatocellular carcinoma treatment response. It refines criteria to accurately distinguish viable tumors from post-treatment changes, improving HCC management.

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Area of Science:

  • Radiology
  • Hepatobiliary Imaging
  • Oncology

Background:

  • The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) is crucial for standardizing hepatocellular carcinoma (HCC) diagnosis and management.
  • LI-RADS currently includes surveillance, diagnosis (CT, MRI, CEUS), and treatment response assessment (TRA) with CT/MRI.
  • Expansion to include CEUS TRA for nonradiation therapies is a recent advancement.

Purpose of the Study:

  • To provide an overview of the LI-RADS CEUS Nonradiation TRA v2024.
  • To detail the imaging findings, techniques, and criteria for assessing posttreatment tumor viability using CEUS.
  • To outline the updated algorithm for assigning LI-RADS treatment response categories.

Main Methods:

  • Review and synthesis of LI-RADS CEUS Nonradiation TRA v2024 guidelines.
  • Description of CEUS imaging findings specific to viable tumor and posttreatment changes.
  • Explanation of distinct diagnostic criteria for intralesional and perilesional enhancement.

Main Results:

  • LI-RADS CEUS Nonradiation TRA v2024 incorporates specific considerations for CEUS appearance of viable tumor and posttreatment changes.
  • Recognizes that posttreatment reactive changes can mimic viable tumor due to perilesional enhancement without washout.
  • Employs broader intralesional and stricter perilesional enhancement criteria to enhance accuracy.

Conclusions:

  • The v2024 update refines CEUS criteria for nonradiation TRA in HCC.
  • Improved accuracy in differentiating viable tumor from reactive changes is achieved.
  • The TRA algorithm assigns standardized LR-TR categories (nonviable, equivocal, viable) for better patient management.