LI-RADS ® 2017/2018 Calculator

LI-RADS® v. 2017/2018

ACR's Liver Imaging Reporting & Data System, for describing findings of hepatocellular carcinoma (HCC) on CT, MRI, US, and CEUSPlease note that the updated LI-RADS US (renamed as LI-RADS Surveillance US) is expected in December 2023, which will be available on RadAide shortly after it is published.

Which imaging modality do you want to report for?

CT/MRI

Contrast-enhanced Ultrasound

Ultrasound

LI-RADS: CT/MRI

What kind of observation do you want to evaluate? *

Untreated

Treated

No observations identified

Negative Study

Recommendation: Return to surveillance in 6 months

Treated Observations

Which option best describes the imaging findings? *

No lesional enhancement

Treatment-specific expected enhancement pattern

Nodular, masslike, or thick irregular tissue in or along the treated lesion with Arterial phase hyperenhancement

Nodular, masslike, or thick irregular tissue in or along the treated lesion with Washout appearance

Nodular, masslike, or thick irregular tissue in or along the treated lesion with Enhancement similar to pretreatment

Enhancement atypical for treatment-specific expected enhancement pattern and not meeting criteria for any of the above options

Treatment response cannot be evaluated due to image degradation or omission

LR-TR Nonevaluable

Recommendation: Continue monitoring in ≤ 3
months with:
• Same modality, OR
• Different modality

LR-TR Nonviable

Recommendation: Continue monitoring in ≤ 3
months with:
• Same modality, OR
• Different modality

LR-TR Equivocal

Recommendation: Continue monitoring in ≤ 3
months with:
• Same modality, OR
• Different modality

LR-TR Viable

Recommendation: Multi-disciplinary
discussion for consensus management - Often includes retreatment

Untreated Observations

Does any of the following apply? *

Exam is compromised by image degradation or omission

The observation is definitely benign

The observation is probably benign

There is definite tumor in vein (TIV)

Probably or definitely malignant but not HCC specific

None of the above apply

Does the observation show any of the following features? (select all that apply)

Enhancing “capsule”

Nonperipheral washout*

Threshold growth (size increase of a mass by ≥ 50% in ≤ 6 months)

*Nonperipheral visually assessed temporal reduction in enhancement in whole or in part relative to composite liver tissue from earlier to later phase resulting in hypoenhancement in the extracellular phase

Does the observation show nonrim-like enhancement in arterial phase? *

Yes

No arterial phase enhancement

What is the outer-edge-to-outer-edge dimension of the observation (including "capsule")? *

<10 mm

10-19 mm

≥ 20 mm

Does the observation have any ancillary features? *

At least one ancillary feature favoring malignancy‡

At least one ancillary feature favoring benignity§

At least one ancillary feature favoring malignancy‡ AND at least one ancillary feature favoring benignity§

Neither

§ Ancillary features favoring malignancy:

US visibility as discrete nodule
Subthreshold growth
Restricted diffusion
Mild-moderate T2 hyperintensity
Corona enhancement
Fat sparing in solid mass
Iron sparing in solid mass,
Transitional phase hypointensity
Hepatobiliary phase hypointensity
Nonenhancing “capsule”
Nodule-in-nodule
Mosaic architecture
Blood products in mass
Fat in mass more than adjacent liver

§§ Ancillary features favoring benignity:

Size stability > 2 yrs
Size reduction
Parallels blood pool, Undistorted vessels
Iron in mass more than liver
Marked T2 hyperintensity
Hepatobiliary phase isointensity

LR-NC

Recommendation: Repeat or alternative diagnostic imaging in ≤ 3 months

LR-TIV

Recommendation: Multidisciplinary discussion for tailored workup - May include biopsy

LR-M

Recommendation: Multidisciplinary discussion for tailored workup - Often includes biopsy

LR-1

Recommendation: Return to surveillance in 6 months

LR-2

Recommendation: Return to surveillance in 6 months - Consider repeat diagnostic imaging in ≤ 6 months

LR-3

Recommendation: Repeat or alternative diagnostic imaging in 3-6 months

LR-3

Recommendation: Repeat or alternative diagnostic imaging in 3-6 months

LR-3

Recommendation: Repeat or alternative diagnostic imaging in 3-6 months

LR-4

Recommendation: Multidisciplinary discussion for tailored workup - May include biopsy

LR-4

Recommendation: Multidisciplinary discussion for tailored workup - May include biopsy

LR-4

Recommendation: Multidisciplinary discussion for tailored workup - May include biopsy

LR-4

Recommendation: Multidisciplinary discussion for tailored workup - May include biopsy

LR-5 (HCC Confirmed)

Recommendation: Multidisciplinary discussion for consensus management

LR-5 (HCC Confirmed)

Recommendation: Multidisciplinary discussion for consensus management

LR-5 (HCC Confirmed)

Recommendation: Multidisciplinary discussion for consensus management

If you are human, leave this field blank.

Start Over

LI-RADS: CEUS

What kind of observation do you want to evaluate? *

Untreated

Treated

No observations identified

CEUS LI-RADS® v2017 does not address treatment response assessment

Negative Study

Recommendation: Management depends on context:

• CEUS is attempted because of positive screening or surveillance US exam: recommend return to routine surveillance.

• CEUS is attempted to further characterize a CT/MRI LR-3, LR-4, or LR-M observation: recommend alternative imaging with CT or MRI

Should be reported in Impression. “No observation on precontrast US. Therefore, CEUS not performed.”

Untreated Observations

Does any of the following apply? *

Exam is compromised by image degradation or omission

The observation is definitely benign

The observation is probably benign

There is definite tumor in vein (TIV)

None of the above apply

How does the observation behave in the arterial phase? *

No arterial phase hyperenhancement

Rim arterial phase hyperenhancement

Peripheral discontinuous globular arterial phase hyperenhancement

Other type of arterial phase hyperenhancement

What is the outer-edge-to-outer-edge dimension of the observation (including "capsule")? *

<20 mm

≥ 20 mm

What is the outer-edge-to-outer-edge dimension of the observation (including "capsule")? *

<10 mm

≥ 10 mm

How is the observation's washout? *

No washout of any type

Late and mild washout

Early (< 60 s) washout

Marked washout

Does the observation have any ancillary features? *

At least one ancillary feature favoring malignancy*

At least one ancillary feature favoring benignity**

At least one ancillary feature favoring malignancy* AND at least one ancillary feature favoring benignity**

Neither

* Ancillary features favoring malignancy: Definite growth, Nodule-in-nodule architecture, Mosaic architecture
** Ancillary features favoring benignity: Size stability ≥ 2 yrs, Size reduction

CEUS LR-NC

Recommendation: Repeat CEUS in ≤ 3 months

Reasonable alternative option: MRI or CT in ≤ 3 months

Must be reported in Findings and Impression. Provide causative technical limitations or artifacts, and work-up suggestions.

CEUS LR-TIV

Recommendation: Multidisciplinary discussion for consensus management. May include biopsy or biomarker correlation to determine etiology of TIV: HCC, ICC, other

If contiguous with CEUS LR-5 -> “Definitely due to HCC”
If contiguous with CEUS LR-4 -> “Probably due to HCC”
If associated with infiltrative mass -> “Probably due to HCC”
If contiguous with CEUS LR-M -> “May be due to non-HCC malignancy”
Otherwise -> “Etiology uncertain”

Must be reported in Findings and Impression. Indicate likely etiology (HCC, nonHCC, unsure); describe vessel(s) involved