FAQ-063: How many observations should I report individually?
Use your judgment in deciding how many observations to report individually, in aggregate, or as a combination of both to convey clinically relevant findings and impression most clearly.
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FAQ-064: What should I report if I see no concerning observations?
LR-1 and LR-2 observations can be reported in aggregate in the Findings. The Impression should convey a simple summary statement such as “no LI-RADS observations suspicious for malignancy”.
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FAQ-065: How should I report a treated observation?
Report the current response category and current tumor viable size if appropriate. Also, whenever possible, report the pretreatment LI-RADS category (or path diagnosis), and the pretreatment size. For example:
- LR-TR Nonviable, (pretreatment LR-5, 22 mm)
- LR-TR Viable 20 mm, (pretreatment, LR-5, 32 mm)
- LR-TR Equivocal 15 mm, (pretreatment path-proven HCC, 21 mm
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FAQ-066: Any special reporting considerations for transplant candidates with HCC?
A standard CT/MRI LI-RADS report contains the needed information for transplant candidates with HCC: number and size of LR-5 observations and path-proven HCCs, or their viable tumor sizes if treated by a locoregional therapy. List major features for each LR-5 observation to enable conversion to OPTN classes. Remember that although categorized LR-5, 10-19 mm observations with APHE and washout appearance as the only additional major feature do not qualify as OPTN Class 5A for HCC exception points for liver transplant in the USA Also report LR-M and LR-TIV observations, as these may affect pretransplant workup and transplant eligibility.
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FAQ-067: What should I report if an observation is biopsied and has a path-proven diagnosis?
This depends on the path diagnosis:
- If malignant or if benign of non-hepatocellular origin (e.g., hemangioma): report observation’s path diagnosis, clinically relevant imaging features, and change since prior: e.g., ”path-proven hemangioma, stable in size and other imaging features since prior.”
- If benign of hepatocellular origin (e.g., regenerative or dysplastic nodule): report observation’s LI-RADS category and pathology diagnosis, imaging features, and change since prior: e.g., “LR-4 with path diagnosis of dysplastic nodule, has new APHE and interval growth from 12 to 16 mm.”
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FAQ-068: What if the path diagnosis is discordant with the LI-RADS category?
Indicate in your report there is discordance, providing the LI-RADS category and the path diagnosis. Explain briefly why this represents a discordance. Consider multidisciplinary discussion with consensus review of the histology, imaging, and other clinical data to adjudicate the discordance.
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FAQ-069: If I am not supposed to assign a LI-RADS category for path-proven observations, why am I supposed to report their imaging features and change since prior?
Radiologists should continue to characterize major features and key ancillary features for biopsy-proven observations as changes in these features may be clinically relevant. Examples: “Path-proven cholangiocarcinoma with interval growth, based on imaging, from 22 mm to 28 mm” or “Path-proven HCC with interval development, based on imaging, of tumor in vein”.
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FAQ-070: How should I report LR-TIV?
Indicate most likely etiology (HCC, non-HCC, unsure) if possible. Also describe vessel(s) involved as well as presence and size of associated parenchymal mass.
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FAQ-071: Why should I report the most likely etiology of TIV if possible?
One of the main goals of LI-RADS is to facilitate clear communication. Sometimes imaging features allow the radiologist to narrow the list of likely TIV etiologies. In those circumstances, communicating clearly the most likely etiology may help guide patient management even if there is less than 100% certainty.
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FAQ-072: How should I report LR-M?
Report major features, growth, contributory ancillary and other features. Indicate relevant change since prior. Indicate most likely etiology if possible.
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FAQ-073: If imaging does not differentiate the various LR-M tumor types with 100% certainty, why should I report the most likely etiology when possible?
One of the main goals of LI-RADS is to facilitate clear communication. Sometimes imaging features allow the radiologist to narrow the list of likely tumor types. In those circumstances, communicating clearly the most likely tumor type(s) may help guide patient management even if there is less than 100% certainty.
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FAQ-074: What should I report if an observation met threshold growth criteria previously but not on the current exam?
If a mass meets the threshold growth criterion at any point, threshold growth is characterized as present on all subsequent exams (i.e., threshold growth “positivity” carries over to future exams). Therefore continue to characterize threshold growth as being present. Report the change in size from the most recent prior and, if possible, the date when the threshold growth criterion was last met.
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FAQ-075: What should I do if the LI-RADS category assigned using LI-RADS criteria does not adequately convey the actual likelihood of malignancy based on my judgment?
Report LI-RADS category and your judgment assessment: e.g., “LR-4, highly likely to be HCC."
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FAQ-076: What should I report for LR-NC observations?
Report causative technical limitations or artifacts, and work-up suggestions. In particular indicate whether the causative technical limitation or artifact is resolvable using the same imaging method or whether a different modality or contrast agent is needed to yield a high quality exam in the future.
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FAQ-077: What should I report if there are no concerning observations but one or more required sequences is missing or degraded by severe artifact?
Report that although there are no concerning observations, the exam is limited technically, which may reduce sensitivity for small masses. Suggest consideration for repeat imaging with the same (if the limitation is resolvable) or other (if the limitation is not resolvable) method.
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FAQ-078: Where do I find report templates to use in my practice and examples of LI-RADS reports?
The computer assisted reporting tool can be found here. Templates and examples can be found in Chapter 14 of the LI-RADS v2018 CT/MRI Manual.