RADS - Reporting and Data Systems Support

FAQ-134: What is a CEUS LI-RADS observation? How does it differ from a CT/MRI observation?

An observation is a distinctive area compared to background liver at imaging. On CT and MRI, it may be a lesion or pseudolesion such as an arterioportal shunt. Unlike in CT or MRI, vascular pseudolesions are not seen on CEUS. Thus, almost all CEUS observations are true lesions.  

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FAQ-135: I am not sure if my patient has cirrhosis. Can I apply CEUS LI-RADS? 

You can apply CEUS LI-RADS and provide a conditional category. For example: “25 mm mass with APHE and washout. If the patient has cirrhosis or chronic hepatitis B, this meets criteria for CEUS LR-5 (definitely HCC).” If available, you can add elastography to the ultrasound exam to evaluate liver stiffness (or shear wave speed). If the elastographic measurement exceeds a validated threshold for cirrhosis using your scanner, you may provide a provisional CEUS LI-RADS category, making sure to comment that this assumes a diagnosis of cirrhosis as suggested by “ultrasound elastography stiffness of [XX] kPa (or shear wave speed of [XX] m/s)”. 

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FAQ-136: I do not see a lesion on precontrast US, can I do CEUS? 

CEUS LI-RADS v2018 applies only to observations visible on precontrast US. Although CEUS LI-RADS does not yet address CEUS of nodules occult on precontrast US, expert CEUS practitioners may use anatomic landmarks to co-localize and assess CT- or MRI-detected observations. 

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FAQ-137:Can CEUS LI-RADS be used in transplant candidates? 

CEUS LI-RADS can be used in transplant candidates if indicated clinically. Since UNOS does not officially recognize CEUS, however, a patient with a CEUS LR-5 observation needs multiphasic CT/MRI for diagnosis verification and staging prior to receiving HCC exception points. 

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FAQ-138: I have seen other systems called CEUS LI-RADS. Which is the official version? 

ACR CEUS LI-RADS® is the official CEUS system endorsed by the ACR. It was developed by an international working group of experts, received critical feedback from and was approved by the ACR LI-RADS Steering Committee, and is included in the ACR LI-RADS Manual along with companion US and CT/MRI systems. Other schemes called "CEUS LI-RADS” are not ACR endorsed, Steering Committee approved, or included in the ACR LI-RADS Manual. 

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FAQ-139: Why does LI-RADS not apply to patients without risk factors, to patients less than 18 years old, or to patients with cirrhosis due to congenital hepatic fibrosis?  

See CT/MRI LI-RADS Core 

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FAQ-140: 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? 

See CT/MRI LI-RADS Core 

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FAQ-141: Why shouldn’t I assign a LI-RADS category for path-proven malignancies and for path-proven benign lesions of non-hepatocellular origin? 

See CT/MRI LI-RADS Core 

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FAQ-142:Should I assign a LI-RADS category to path-proven benign lesions of hepatocellular origin (e.g., regenerative or dysplastic nodules)? 

See CT/MRI LI-RADS Core 

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