RADS - Reporting and Data Systems Support

FAQ-157: Why does CEUS LI-RADS require reporting of each observation individually while CT/MRI LI-RADS allows aggregate reporting in some circumstances?

A primary goal of LI-RADS is to facilitate clear and simple communication between radiologists, other specialists, and patients. CT and MRI sometimes detect so many observations and with such a broad range of clinical relevance that reporting all observations individually may clutter the report with unnecessary detail and obscure the main message. To communicate simply and clearly, radiologists are given the discretion to report CT and MRI observations in aggregate. By comparison, CEUS is a focused exam that evaluates a limited number of specifically targeted observations. Since only a limited number of specifically targeted observations are evaluated, each observation should be reported individually.  

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FAQ-158: How do I categorize and report a treated lesion? 

If you encounter a treated lesion during CEUS, describe any suspicious areas of enhancement or washout in or along the treatment area, including their size(s), as well their change since prior. If appropriate, include your confidence level and suggestions for further management. For example, 

• “12 mm nodular area along the treatment margin with arterial phase hyperenhancement and washout, highly suggestive of viable tumor.” 

OR 

• “Thick rim of slowly progressive enhancement along the treatment margin without washout. This may represent benign posttreatment change or ischemic tumor. In my opinion, this is equivocal for viability. Consider MDD for individualized workup and management.”

Since CEUS LI-RADS treatment response criteria are not yet available, do not assign a formal CEUS LI-RADS treatment response category and consider further evaluation with CT or MRI when a treated lesion is encountered.

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FAQ-159: What should I report if an observation is biopsied and and has a path-proven diagnosis? 

This depends on the pathology diagnosis: 

• If malignant or if benign of non-hepatocellular origin (e.g., hemangioma): report observation’s pathology diagnosis, clinically relevant imaging features, and change since prior. 

• If benign of hepatocellular origin (e.g., regenerative or dysplastic nodule): report observation’s CEUS LI-RADS category and path diagnosis, imaging features, and change since prior. Also specify the date of pathology acquisition as the lesion may have changed over time, especially if the biopsy-imaging time interval is long.

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FAQ-160: What should I do if the path diagnosis of a biopsied observation is discordant with the CEUS LI-RADS category?

Indicate in your report there is discordance, providing the CEUS LI-RADS category and the path diagnosis. Specify the date of pathology acquisition as the lesion may have changed over time. Explain briefly why you believe 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-161: Where do I find report templates to use in my practice and examples of CEUS LI-RADS reports?

These can be downloaded from the ACR LI-RADS webpage under Related Resources.

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