RADS - Reporting and Data Systems Support

FAQ-001: Why does LI-RADS not apply to patients without risk factors, to patients < 18 years old, or to patients with cirrhosis due to congenital hepatic fibrosis?

The positive predictive value of imaging for HCC may not be sufficiently high in such patients.  

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FAQ-002: Why does LI-RADS not apply to patients with cirrhosis due to a vascular disorder such as hereditary hemorrhagic telangiectasia, Budd-Chiari syndrome, chronic portal vein occlusion, cardiac congestion, or diffuse nodular regenerative hyperplasia?

Such conditions are associated with formation of benign hyperplastic nodules that may resemble HCC on imaging, potentially causing false positive diagnoses. 

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FAQ-003: I am not sure if my patient has cirrhosis. Can I apply CT/MRI LI-RADS?

You can apply LI-RADS and provide a conditional category. For example: “25 mm mass with APHE and washout appearance. If the patient has cirrhosis or chronic hepatitis B, this meets criteria for LR-5 (definitely HCC).” 

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FAQ-004: My institution is a transplant center and is required to use the OPTN system. Can I use LI-RADS instead of or in addition to OPTN?

Yes, you may use LI-RADS in any patient with cirrhosis, chronic hepatitis B, or current or prior HCC. This includes liver transplant candidates and/or recipients with any of those risk factors. 

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FAQ-005: My patient has active extrahepatic primary malignancy. Can I use LI-RADS?

Yes. LI-RADS may be applied, but assignment of LR-5 should be done with caution because LI-RADS imaging criteria and observation categories were not developed or validated in this setting. Concurrent extrahepatic malignancy reduces the positive predictive value of LR-5 for HCC, especially if the primary tumor is hypervascular. If in doubt, categorize as LR-M rather than LR-5; consider additional imaging and multidisciplinary discussion. 

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FAQ-006: Can I use the LI-RADS diagnostic algorithm in a patient who has cirrhosis and heart failure?

Yes. LI-RADS can be used in a patient with cirrhosis and heart failure, as long as the cirrhosis is not due to the heart failure or other vascular disorder. 

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FAQ-007: Why does LI-RADS not apply to single-phase CT or MRI exams?

Characterization of all LI-RADS major imaging features is possible only if multiple imaging phases are acquired. 

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FAQ-008: How do I interpret and report observations on single-phase CT or MRI in at-risk patients?

Provide your best diagnosis or differential diagnosis. Suggest multiphase CT or MRI if a formal LI-RADS categorization would help in patient management. 

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FAQ-009: Why shouldn’t I assign a LI-RADS category for path-proven malignancies and for path-proven benign lesions of non-hepatocellular origin?  

LI-RADS is intended to clarify communication. Assigning a LI-RADS category to a pathologically proven lesion (in which there is now certainty about the diagnosis) may cause confusion, especially for LI-RADS categories that convey some uncertainty (i.e., LR-2, LR-3, LR-4, or LR-M). 

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FAQ-010: Should I assign a LI-RADS category to path-proven benign lesions of hepatocellular origin (e.g., regenerative or dysplastic nodules)?

These are exceptions to the prior rule. For path-proven regenerative or dysplastic nodules, assign a LI-RADS category in addition to the path diagnosis. Assigning LI-RADS categories alleviates potential harm from false-negative pathology, facilitates monitoring of nodules for possible progression, and informs management decisions. 

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