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Hepatobiliary agents and their role in LI-RADS

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Abstract

The Liver Imaging Reporting and Data System (LI-RADS) was introduced with the goal of standardizing the diagnosis of hepatocellular carcinoma. The 2014 version of LI-RADS incorporates the use of hepatobiliary contrast agents (HBAs) into the diagnostic algorithm, including gadoxetate disodium and gadobenate dimeglumine. Three new ancillary features are introduced: hepatobiliary phase (HBP) hypointensity and HBP hypointense rim favor malignancy, while HBP isointensity favors benignity. HBP hyperintensity favors neither malignancy nor benignity. In this review, we describe how to use these new features as well as numerous pitfalls associated with the use ofHBAs, including hemangiomas, cholangiocarcinomas, and focal confluent fibrosis. Importantly, findings on the HBP are not included as major criteria and therefore the criteria for the diagnosis of LI-RADS 5 observations remain unchanged, and so congruence with the Organ Procurement Transplant Network system remains intact. Additionally, we review how the major features in LI-RADS, arterial phase hyperenhancement, threshold growth, and washout and capsule appearance, may be affected with HBAs. Notably with HBAs, hypointensity on the delayed phase, termed the transitional phase, does not qualify as washout appearance due to the possibility of early parenchymal enhancement. It is hoped that the incorporation of HBAs into LI-RADS will help create consistency when interpreting HBA enhanced MRIs.

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Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue – 0628, San Francisco, CA, 94143-0628, USA

    Thomas A. Hope, Judy Yee & Benjamin M. Yeh

  2. Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Kathryn J. Fowler & Jay P. Heiken

  3. Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA

    Claude B. Sirlin & Eduardo A. C. Costa

Authors
  1. Thomas A. Hope
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  2. Kathryn J. Fowler
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  3. Claude B. Sirlin
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  4. Eduardo A. C. Costa
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  5. Judy Yee
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  6. Benjamin M. Yeh
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  7. Jay P. Heiken
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Correspondence to Thomas A. Hope.

Additional information

Hepatobiliary Phase LI-RADS Workgroup are given in “Appendix” section.

Appendix: Hepatobiliary Phase LI-RADS Workgroup Members

Appendix: Hepatobiliary Phase LI-RADS Workgroup Members

Carlo Bartolozzi, Mustafa Bashir, Giuseppe Brancatelli, Victoria Chernyak, Jin-Young Choi, Kathryn Fowler, Masoom Haider, Jay Heiken (workgroup chair), Thomas Hope, Keyanoosh Hosseinzadeh, Hero Hussain, Kartik Jhaveri, Masayuki Kanematsu, Jeong Min Lee, John Leyendecker, Osamu Matsui, Don Mitchell, Elmar Merkle, Giovanni Morana, Takamichi Murakami, Scott Reeder, Jens Ricke, Alla Rozenblit, Wolfgang Schima, Claude Sirlin, Jaap Stoker, Janio Szklaruk, Christoph Zech.

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Hope, T.A., Fowler, K.J., Sirlin, C.B. et al. Hepatobiliary agents and their role in LI-RADS. Abdom Imaging 40, 613–625 (2015). https://doi.org/10.1007/s00261-014-0227-5

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  • DOI: https://doi.org/10.1007/s00261-014-0227-5

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