Abdominal Radiology

, Volume 43, Issue 1, pp 82–100 | Cite as

LI-RADS® ancillary features on CT and MRI

  • Victoria Chernyak
  • An Tang
  • Milana Flusberg
  • Demetri Papadatos
  • Bijan Bijan
  • Yuko Kono
  • Cynthia Santillan
Invited article

Abstract

The Liver Imaging Reporting and Data System (LI-RADS) uses an algorithm to assign categories that reflect the probability of hepatocellular carcinoma (HCC), non-HCC malignancy, or benignity. Unlike other imaging algorithms, LI-RADS utilizes ancillary features (AFs) to refine the final category. AFs in LI-RADS v2017 are divided into those favoring malignancy in general, those favoring HCC specifically, and those favoring benignity. Additionally, LI-RADS v2017 provides new rules regarding application of AFs. The purpose of this review is to discuss ancillary features included in LI-RADS v2017, the rationale for their use, potential pitfalls encountered in their interpretation, and tips on their application.

Keywords

Review article Hepatocellular carcinoma Imaging features Ancillary features Malignancy Benignity 

Abbreviations

AF

Ancillary features

AASLD

American Association for the Study of Liver Diseases

ADC

Apparent diffusion coefficient

APHE

Arterial phase hyperenhancement

CT

Computed tomography

DWI

Diffusion-weighted imaging

ECA

Extracellular agents

HCC

Hepatocellular carcinoma

HBP

Hepatobiliary phase

LI-RADS

Liver Imaging Reporting And Data System

MRI

Magnetic resonance imaging

US

Ultrasound

OPTN

ORGAN Procurement and Transplantation Network

PVP

Portal venous phase

TP

Transitional phase

TVDT

Tumor volume doubling time

Notes

Acknowledgements

This work was supported by [1] the Fonds de recherche du Québec—Santé (Career Award#26993), and New Researcher Startup Grant from the Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM) to An Tang.

Compliance with ethical standards

Conflict of interest

V Chernyak, M. Flusberg, D. Papadatos, B. Bijan, C. Santillan: None. A. Tang, MD, MSc: Advisory board member of Imagia Cybernetics. Y. Kono: Research Grant support: Toshiba Medical Systems Co.; Contrast agent support: Lantheus Medical Imaging Inc.; Equipment support: GE Healthcare; Equipment support: Philips Ultrasound.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Wald C, Russo MW, Heimbach JK, et al. (2013) New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 266(2):376–382CrossRefPubMedGoogle Scholar
  2. 2.
    Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1032CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    EASL-EORTC clinical practice guidelines (2012) management of hepatocellular carcinoma. J Hepatol 56(4):908–943CrossRefGoogle Scholar
  4. 4.
    Omata M, Lesmana LA, Tateishi R, et al. (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4(2):439–474CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kudo M, Matsui O, Izumi N, et al. (2014) JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan. Liver Cancer 3(3–4):458–468CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wilson; Kono Y. LI-RADS algorithm: CEUS. Abdom Radiol 2017.Google Scholar
  7. 7.
    Darnell A, Forner A, Rimola J, et al. (2015) Liver imaging reporting and data system with MR imaging: evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275(3):698–707CrossRefPubMedGoogle Scholar
  8. 8.
    Okada S, Okazaki N, Nose H, et al. (1993) Follow-up examination schedule of postoperative HCC patients based on tumor volume doubling time. Hepato-gastroenterology 40(4):311–315PubMedGoogle Scholar
  9. 9.
    Kubota K, Ina H, Okada Y, Irie T (2003) Growth rate of primary single hepatocellular carcinoma: determining optimal screening interval with contrast enhanced computed tomography. Dig Dis Sci 48(3):581–586CrossRefPubMedGoogle Scholar
  10. 10.
    Furlan A, Marin D, Agnello F, et al. (2012) Hepatocellular carcinoma presenting at contrast-enhanced multi-detector-row computed tomography or gadolinium-enhanced magnetic resonance imaging as a small (</ = 2 cm), indeterminate nodule: growth rate and optimal interval time for imaging follow-up. J Comp Assist Tomogr 36(1):20–25CrossRefGoogle Scholar
  11. 11.
    Taouli B, Goh JS, Lu Y, et al. (2005) Growth rate of hepatocellular carcinoma: evaluation with serial computed tomography or magnetic resonance imaging. J Comp Assist Tomogr 29(4):425–429CrossRefGoogle Scholar
  12. 12.
    Park Y, Choi D, Lim HK, et al. (2008) Growth rate of new hepatocellular carcinoma after percutaneous radiofrequency ablation: evaluation with multiphase CT. AJR Am J Roentgenol 191(1):215–220CrossRefPubMedGoogle Scholar
  13. 13.
    Miyayama S, Yamashiro M, Okuda M, et al. (2011) Detection of corona enhancement of hypervascular hepatocellular carcinoma by C-arm dual-phase cone-beam CT during hepatic arteriography. Cardiovasc Interv Radiol 34(1):81–86CrossRefGoogle Scholar
  14. 14.
    Ueda K, Matsui O, Kawamori Y, et al. (1998) Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology 206(1):161–166CrossRefPubMedGoogle Scholar
  15. 15.
    Terayama N, Matsui O, Ueda K, et al. (2002) Peritumoral rim enhancement of liver metastasis: hemodynamics observed on single-level dynamic CT during hepatic arteriography and histopathologic correlation. J Comput Assist Tomogr 26(6):975–980CrossRefPubMedGoogle Scholar
  16. 16.
    Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y (2009) Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography–radiologic–pathologic correlation. Radiology 252(2):605–614CrossRefPubMedGoogle Scholar
  17. 17.
    Santillan C FK, Kono Y, Chernyak V. LI-RADS major features: CT, MRI with ECA, and MRI with HBA. Abdom Radiol 2017.Google Scholar
  18. 18.
    Bruegel M, Holzapfel K, Gaa J, et al. (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18(3):477–485CrossRefPubMedGoogle Scholar
  19. 19.
    Taouli B, Vilgrain V, Dumont E, et al. (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226(1):71–78CrossRefPubMedGoogle Scholar
  20. 20.
    Le Moigne F, Durieux M, Bancel B, et al. (2012) Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver. Magn Reson Imaging 30(5):656–665CrossRefPubMedGoogle Scholar
  21. 21.
    Xu PJ, Yan FH, Wang JH, et al. (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34(4):506–512CrossRefPubMedGoogle Scholar
  22. 22.
    Kwon HJ, Byun JH, Kim JY, et al. (2015) Differentiation of small (</ = 2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images. Abdom Imaging 40(1):64–75CrossRefPubMedGoogle Scholar
  23. 23.
    Nasu K, Kuroki Y, Tsukamoto T, et al. (2009) Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. AJR Am J Roentgenol 193(2):438–444CrossRefPubMedGoogle Scholar
  24. 24.
    Hwang J, Kim YK, Park MJ, et al. (2012) Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI. J Magn Reson Imaging 36(4):881–889CrossRefPubMedGoogle Scholar
  25. 25.
    Kim YK, Lee WJ, Park MJ, et al. (2012) Hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis: potential of DW imaging in predicting progression to hypervascular HCC. Radiology 265(1):104–114CrossRefPubMedGoogle Scholar
  26. 26.
    Taouli B, Koh DM (2010) Diffusion-weighted MR imaging of the liver. Radiology 254(1):47–66CrossRefPubMedGoogle Scholar
  27. 27.
    Park HJ, Kim YK, Park MJ, Lee WJ (2013) Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma. Abdom Imaging. 38(4):793–801CrossRefPubMedGoogle Scholar
  28. 28.
    Di Martino M, Anzidei M, Zaccagna F, et al. (2016) Qualitative analysis of small (</ = 2 cm) regenerative nodules, dysplastic nodules and well-differentiated HCCs with gadoxetic acid MRI. BMC Med Imaging 16(1):62CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Li CS, Chen RC, Lii JM, et al. (2006) Magnetic resonance imaging appearance of well-differentiated hepatocellular carcinoma. J Comput Assist Tomogr 30(4):597–603CrossRefPubMedGoogle Scholar
  30. 30.
    Rhee H, Kim MJ, Park YN, Choi JS, Kim KS (2012) Gadoxetic acid-enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria. J Magn Reson Imaging 35(2):393–398CrossRefPubMedGoogle Scholar
  31. 31.
    Kelekis NL, Semelka RC, Worawattanakul S, et al. (1998) Hepatocellular carcinoma in North America: a multiinstitutional study of appearance on T1-weighted, T2-weighted, and serial gadolinium-enhanced gradient-echo images. AJR Am J Roentgenol 170(4):1005–1013CrossRefPubMedGoogle Scholar
  32. 32.
    Enomoto S, Tamai H, Shingaki N, et al. (2011) Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis. Hepatol Int 5(2):730–737CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    van den Bos IC, Hussain SM, Dwarkasing RS, et al. (2007) MR imaging of hepatocellular carcinoma: relationship between lesion size and imaging findings, including signal intensity and dynamic enhancement patterns. J Magn Reson Imaging 26(6):1548–1555CrossRefPubMedGoogle Scholar
  34. 34.
    Ebara M, Fukuda H, Kojima Y, et al. (1999) Small hepatocellular carcinoma: relationship of signal intensity to histopathologic findings and metal content of the tumor and surrounding hepatic parenchyma. Radiology 210(1):81–88CrossRefPubMedGoogle Scholar
  35. 35.
    Kamura T, Kimura M, Sakai K, et al. (2002) Small hypervascular hepatocellular carcinoma versus hypervascular pseudolesions: differential diagnosis on MRI. Abdom Imaging. 27(3):315–324CrossRefPubMedGoogle Scholar
  36. 36.
    Hyodo T, Murakami T, Imai Y, et al. (2013) Hypovascular nodules in patients with chronic liver disease: risk factors for development of hypervascular hepatocellular carcinoma. Radiology 266(2):480–490CrossRefPubMedGoogle Scholar
  37. 37.
    Jha RC, Zanello PA, Nguyen XM, et al. (2014) Small hepatocellular carcinoma: MRI findings for predicting tumor growth rates. Acad Radiol 21(11):1455–1464CrossRefPubMedGoogle Scholar
  38. 38.
    Rosenkrantz AB, Lee L, Matza BW, Kim S (2012) Infiltrative hepatocellular carcinoma: comparison of MRI sequences for lesion conspicuity. Clin Radiol 67(12):e105–e111CrossRefPubMedGoogle Scholar
  39. 39.
    Cruite I, Schroeder M, Merkle EM, Sirlin CB (2010) Gadoxetate disodium-enhanced MRI of the liver: part 2, protocol optimization and lesion appearance in the cirrhotic liver. AJR Am J Roentgenol 195(1):29–41CrossRefPubMedGoogle Scholar
  40. 40.
    Lee MH, Kim SH, Park MJ, Park CK, Rhim H (2011) Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol 197(5):W868–W875CrossRefPubMedGoogle Scholar
  41. 41.
    Choi SH, Byun JH, Lim YS, et al. (2016) Diagnostic criteria for hepatocellular carcinoma 3 cm with hepatocyte-specific contrast-enhanced magnetic resonance imaging. J Hepatol 64(5):1099–1107CrossRefPubMedGoogle Scholar
  42. 42.
    Bartolozzi C, Battaglia V, Bargellini I, et al. (2013) Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging 38(2):290–296CrossRefPubMedGoogle Scholar
  43. 43.
    Cortis K, Liotta R, Miraglia R, et al. (2016) Incorporating the hepatobiliary phase of gadobenate dimeglumine-enhanced MRI in the diagnosis of hepatocellular carcinoma: increasing the sensitivity without compromising specificity. Acta Radiol 57(8):923–931CrossRefPubMedGoogle Scholar
  44. 44.
    Orlacchio A, Chegai F, Fabiano S, et al. (2016) Role of MRI with hepatospecific contrast agent in the identification and characterization of focal liver lesions: pathological correlation in explanted livers. La Radiol Med 121(7):588–596CrossRefGoogle Scholar
  45. 45.
    Hope TA, Fowler KJ, Sirlin CB, et al. (2015) Hepatobiliary agents and their role in LI-RADS. Abdom Imaging 40(3):613–625CrossRefPubMedGoogle Scholar
  46. 46.
    An C, Rhee H, Han K, et al. (2016) Added value of smooth hypointense rim in the hepatobiliary phase of gadoxetic acid-enhanced MRI in identifying tumour capsule and diagnosing hepatocellular carcinoma. Eur Radiol 27:2610–2618CrossRefPubMedGoogle Scholar
  47. 47.
    Dioguardi Burgio M, Picone D, Cabibbo G, et al. (2016) MR-imaging features of hepatocellular carcinoma capsule appearance in cirrhotic liver: comparison of gadoxetic acid and gadobenate dimeglumine. Abdom Radiol 41:1546–1554CrossRefGoogle Scholar
  48. 48.
    Suh YJ, Kim MJ, Choi JY, et al. (2011) Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol 197(1):W44–W52CrossRefPubMedGoogle Scholar
  49. 49.
    Chong YS, Kim YK, Lee MW, et al. (2012) Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol 67(8):766–773CrossRefPubMedGoogle Scholar
  50. 50.
    Kim R, Lee JM, Shin CI, et al. (2016) Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 26(6):1808–1817CrossRefPubMedGoogle Scholar
  51. 51.
    Stevens WR, Gulino SP, Batts KP, Stephens DH, Johnson CD (1996) Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance. J Comput Assist Tomogr 20(3):337–342CrossRefPubMedGoogle Scholar
  52. 52.
    Choi BI, Takayasu K, Han MC (1993) Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. AJR Am J Roentgenol 160(6):1177–1187CrossRefPubMedGoogle Scholar
  53. 53.
    Yoshida T, Matsue H, Okazaki N, Yoshino M (1987) Ultrasonographic differentiation of hepatocellular carcinoma from metastatic liver cancer. J Clin Ultrasound 15(7):431–437CrossRefPubMedGoogle Scholar
  54. 54.
    Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M (2000) Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol 33(2):282–289CrossRefPubMedGoogle Scholar
  55. 55.
    Park HJ, Jang KM, Kang TW, et al. (2016) Identification of imaging predictors discriminating different primary liver tumours in patients with chronic liver disease on gadoxetic acid-enhanced MRI: a classification tree analysis. Eur Radiol 26(9):3102–3111CrossRefPubMedGoogle Scholar
  56. 56.
    Sheng RF, Zeng MS, Ji Y, et al. (2015) MR features of small hepatocellular carcinoma in normal, fibrotic, and cirrhotic livers: a comparative study. Abdom Imaging 40(8):3062–3069CrossRefPubMedGoogle Scholar
  57. 57.
    Ebara M, Hatano R, Fukuda H, et al. (1998) Natural course of small hepatocellular carcinoma with underlying cirrhosis. A study of 30 patients. Hepato-gastroenterology 45(Suppl 3):1214–1220PubMedGoogle Scholar
  58. 58.
    Yamagata M, Masaki T, Okudaira T, et al. (1999) Small hyperechoic nodules in chronic liver diseases include hepatocellular carcinomas with low cyclin D1 and Ki-67 expression. Hepatology 29(6):1722–1729CrossRefPubMedGoogle Scholar
  59. 59.
    Huz JI, Melis M, Sarpel U (2012) Spontaneous regression of hepatocellular carcinoma is most often associated with tumour hypoxia or a systemic inflammatory response. HPB 14(8):500–505CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Tamada T, Ito K, Yamamoto A, et al. (2011) Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium. AJR Am J Roentgenol 196(4):824–830CrossRefPubMedGoogle Scholar
  61. 61.
    Kim B, Byun JH, Kim HJ, et al. (2016) Enhancement patterns and pseudo-washout of hepatic haemangiomas on gadoxetate disodium-enhanced liver MRI. Eur Radiol 26(1):191–198CrossRefPubMedGoogle Scholar
  62. 62.
    Brancatelli G, Federle MP, Blachar A, Grazioli L (2001) Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 219(1):69–74CrossRefPubMedGoogle Scholar
  63. 63.
    Krinsky GA, Lee VS, Nguyen MT, et al. (2000) Siderotic nodules at MR imaging: regenerative or dysplastic? J Comput Assist Tomogr 24(5):773–776CrossRefPubMedGoogle Scholar
  64. 64.
    Krinsky GA, Zivin SB, Thorner KM, et al. (2002) Low-grade siderotic dysplastic nodules: determination of premalignant lesions on the basis of vasculature phenotype. Acad Radiol 9(3):336–341CrossRefPubMedGoogle Scholar
  65. 65.
    Zhang J, Krinsky GA (2004) Iron-containing nodules of cirrhosis. NMR Biomed 17(7):459–464CrossRefPubMedGoogle Scholar
  66. 66.
    Krinsky GA, Lee VS, Nguyen MT, et al. (2001) Siderotic nodules in the cirrhotic liver at MR imaging with explant correlation: no increased frequency of dysplastic nodules and hepatocellular carcinoma. Radiology 218(1):47–53CrossRefPubMedGoogle Scholar
  67. 67.
    Ringe KI, Husarik DB, Sirlin CB, Merkle EM (2010) Gadoxetate disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion appearance in the noncirrhotic liver. AJR Am J Roentgenol 195(1):13–28CrossRefPubMedGoogle Scholar
  68. 68.
    Ahn SJ, Kim MJ, Hong HS, Kim KA, Song HT (2011) Distinguishing hemangiomas from malignant solid hepatic lesions: a comparison of heavily T2-weighted images obtained before and after administration of gadoxetic acid. J Magn Resone Imaging 34(2):310–317CrossRefGoogle Scholar
  69. 69.
    Del Poggio P, Buonocore M (2008) Cystic tumors of the liver: a practical approach. World J Gastroenterol 14(23):3616–3620CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Silva AC, Evans JM, McCullough AE, et al. (2009) MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 29(2):385–402CrossRefPubMedGoogle Scholar
  71. 71.
    Ahn JH, Yu JS, Hwang SH, et al. (2010) Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol 20(2):385–394CrossRefPubMedGoogle Scholar
  72. 72.
    Kim JI, Lee JM, Choi JY, et al. (2008) The value of gadobenate dimeglumine-enhanced delayed phase MR imaging for characterization of hepatocellular nodules in the cirrhotic liver. Investig Radiol. 43(3):202–210CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Montefiore Medical CenterBronxUSA
  2. 2.Department of Radiology, Radio-Oncology and Nuclear MedicineUniversité de MontréalMontrealCanada
  3. 3.Department of Diagnostic ImagingThe Ottawa HospitalOttawaCanada
  4. 4.Sutter Imaging (SMG)/University of California Davis (UCD)SacramentoUSA
  5. 5.Department of Medicine, Gastroenterology and HepatologyUniversity of CaliforniaSan DiegoUSA
  6. 6.Liver Imaging Group, Department of RadiologyUniversity of CaliforniaSan DiegoUSA

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