Modified on: Tue, 19 Oct, 2021 at 10:25 AM
FAQ-130: A patient presenting for US HCC screening/surveillance has a complex cyst. How should I report this finding?
The US LI-RADS report should have a field for other important findings. For example, a complex cyst could be reported as:
US-1, Negative -- No US evidence of HCC
Other: xx-cm complex cyst in [right, left] lobe. Recommend [provide recommendation based on your assessment]
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FAQ-131: How should biliary ductal dilatation be categorized on US LI-RADS?
The US LI-RADS report should have a field for other important findings. Although biliary ductal dilatation as an isolated finding is uncommon in HCC, it may indicate an underlying pathologic abnormality, especially if new or associated with abnormal liver function tests and should be further evaluated. Biliary ductal dilatation may be reported as follows:
US-1, Negative -- No US evidence of HCC
Other: New [intrahepatic/extrahepatic/intrahepatic and extrahepatic biliary ductal dilatation/other] Recommend [provide recommendation based on your assessment such as further characterization with multiphase contrast enhanced CT/MRI/US or MRCP.]
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FAQ-132: If an US-2 observation is unchanged on subsequent US exams, how long should it be followed at 3-6 month intervals until it can be downgraded to an US-1?
If an US-2 observation is stable for 2 years on US, it can be downgraded to an US-1 category
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FAQ-133: Is there a standardized US LI-RADS reporting template that I can use?
Yes. See below for a sample limited abdomen HCC Screening dictation template, which can be tailored to your institution.
HCC SCREENING ABDOMINAL ULTRASOUND CLINICAL HISTORY: [Indication]
COMPARISON: [/none]
PROCEDURE COMMENTS: Ultrasound evaluation of the abdomen was performed, supplemented with color Doppler imaging.
FINDINGS:
Liver: Visualization:
No or minimal limitations in liver visualization.
Moderate limitations in liver visualization.
Severe Limitations in liver visualization.]
[Describe reason for limitation if B or C]
Liver appearance: [Describe features of cirrhosis or other hepatocellular disease, if present.]
Liver length: [#] cm [optional]
Liver observations: [Describe any observations]
Portal veins: [Patency, direction of flow]
Bile ducts: [Not dilated./Dilated]
Common duct: [#] mm
Gallbladder: []
Spleen: [#] cm, []
Other findings: [None/ascites]
IMPRESSION:
[US-1 Negative. Recommend routine surveillance ultrasound in 6 months. /US-2 Subthreshold. Recommend follow-up ultrasound in 3-6 months. (include reason for US-2)/US-3 Positive. Recommend further characterization with multiphase CT, MR, or contrast-enhanced ultrasound. (include reason for US-3)]
[VIS-A No or minimal limitations/VIS-B: Moderate limitations may obscure small masses./VIS-C: Severe limitations may significantly lower sensitivity for focal liver lesions] [reason for VIS-B or VIS-C]
[Other findings]
REFERENCE:
US LI-RADS categories:
US Category:
US-1 - Negative: No evidence of HCC.
US-2 - Subthreshold: Observation detected that may warrant short-interval US surveillance. Observation < 10 mm in diameter, not definitely benign.
US-3 - Positive: Observation detected that may warrant contrast-enhanced imaging. Observation >= 10 mm in diameter OR new thrombus in vein.
Visualization Score:
No or minimal limitations: Limitations, if any, are unlikely to meaningfully affect sensitivity.
Moderate limitations: Limitations may obscure small masses.
Severe limitations: Limitations may significantly lower sensitivity for focal liver lesions.
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