CTSCAN MRI LIRADS 2018 Dr NGUYN H TRC
![CT-SCAN & MRI LIRADS 2018 Dr. NGUYỄN HỒ TRÚC LINH - MRI CT-SCAN & MRI LIRADS 2018 Dr. NGUYỄN HỒ TRÚC LINH - MRI](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-1.jpg)
![v CONTENTS: 1 2 3 4 What’s LIRADS? Which cases is LIRADS Applied and v CONTENTS: 1 2 3 4 What’s LIRADS? Which cases is LIRADS Applied and](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-2.jpg)
![1. WHAT IS LIRADS? Ø Liver Imaging Reporting and Data System – A classification 1. WHAT IS LIRADS? Ø Liver Imaging Reporting and Data System – A classification](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-3.jpg)
![2. ✓ APPLY Ø In patients at high risk for HCC, namely those with: 2. ✓ APPLY Ø In patients at high risk for HCC, namely those with:](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-4.jpg)
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-5.jpg)
![v LR-1 (100% BENIGN): Ø Imaging features diagnostic of a benign entity ü Cyst v LR-1 (100% BENIGN): Ø Imaging features diagnostic of a benign entity ü Cyst](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-6.jpg)
![v LR-2 (PROBABLY BENIGN): Ø Similar to LR-1. Ø A solid <20 mm nodule, v LR-2 (PROBABLY BENIGN): Ø Similar to LR-1. Ø A solid <20 mm nodule,](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-7.jpg)
![v LR-3 ; LR-4 ; LR-5: BASED ON FEATURES: Arterial phase Hyperenhancement (APHE) No v LR-3 ; LR-4 ; LR-5: BASED ON FEATURES: Arterial phase Hyperenhancement (APHE) No](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-8.jpg)
![v LR-3 ; LR-4 ; LR-5 v LR-3 ; LR-4 ; LR-5](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-9.jpg)
![v SPECIAL CATEGORIES: LR-NC (LR-Non Categorizable): ØFor lesions in which the technical quality of v SPECIAL CATEGORIES: LR-NC (LR-Non Categorizable): ØFor lesions in which the technical quality of](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-10.jpg)
![v SPECIAL CATEGORIES: q LR-M: Ø For liver lesions that are probably or definitely v SPECIAL CATEGORIES: q LR-M: Ø For liver lesions that are probably or definitely](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-11.jpg)
![v SPECIAL CATEGORIES: q LR-TIV: Ø For unequivocal enhancing soft tissue invading the portal v SPECIAL CATEGORIES: q LR-TIV: Ø For unequivocal enhancing soft tissue invading the portal](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-12.jpg)
![CASES CASES](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-13.jpg)
![1 ST CASE: • A 65 y. o female patient, with a medical history 1 ST CASE: • A 65 y. o female patient, with a medical history](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-14.jpg)
![PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-15.jpg)
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-16.jpg)
![2 ND CASE: • A 70 y. o male patient, with Chronic hepatitis B 2 ND CASE: • A 70 y. o male patient, with Chronic hepatitis B](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-17.jpg)
![PRE-CONTRAST VENOUS PHASE PRIMOVIST ARTERIAL PHASE Hepatobiliary PHASE PRE-CONTRAST VENOUS PHASE PRIMOVIST ARTERIAL PHASE Hepatobiliary PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-18.jpg)
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-19.jpg)
![3 RD CASE: • A 69 y. o male patient, with Chronic hepatitis infection. 3 RD CASE: • A 69 y. o male patient, with Chronic hepatitis infection.](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-20.jpg)
![PRE-CONTRAST PRIMOVIST VENOUS PHASE ARTERIAL PHASE Hepatobiliary PHASE PRE-CONTRAST PRIMOVIST VENOUS PHASE ARTERIAL PHASE Hepatobiliary PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-21.jpg)
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-22.jpg)
![4 TH CASE: • A 56 y. o female patient, with a medical history 4 TH CASE: • A 56 y. o female patient, with a medical history](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-23.jpg)
![PRE-CONTRAST VENOUS PHASE GADOVIST ARTERIAL PHASE DELAYED PHASE PRE-CONTRAST VENOUS PHASE GADOVIST ARTERIAL PHASE DELAYED PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-24.jpg)
![v LR-2 (PROBABLY BENIGN) Ø Similar to LR-1. Ø A solid <20 mm nodule, v LR-2 (PROBABLY BENIGN) Ø Similar to LR-1. Ø A solid <20 mm nodule,](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-25.jpg)
![5 TH CASE: • A 49 y. o male patient, with Chronic hepatitis infection 5 TH CASE: • A 49 y. o male patient, with Chronic hepatitis infection](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-26.jpg)
![PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-27.jpg)
![4. Treatment and Prognosis LR 1 Continued routine surveillance LR 2 Continued routine surveillance, 4. Treatment and Prognosis LR 1 Continued routine surveillance LR 2 Continued routine surveillance,](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-28.jpg)
![References: Ø https: //radiopaedia. org/articles/li-rads? lang=us Ø https: //www. acr. org/Clinical. Resources/Reporting-and-Data-Systems/LIRADS/CT-MRI-LI-RADS-v 2018 References: Ø https: //radiopaedia. org/articles/li-rads? lang=us Ø https: //www. acr. org/Clinical. Resources/Reporting-and-Data-Systems/LIRADS/CT-MRI-LI-RADS-v 2018](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-29.jpg)
![THANKS FOR LISTENING! THANKS FOR LISTENING!](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-30.jpg)
- Slides: 30
![CTSCAN MRI LIRADS 2018 Dr NGUYỄN HỒ TRÚC LINH MRI CT-SCAN & MRI LIRADS 2018 Dr. NGUYỄN HỒ TRÚC LINH - MRI](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-1.jpg)
CT-SCAN & MRI LIRADS 2018 Dr. NGUYỄN HỒ TRÚC LINH - MRI
![v CONTENTS 1 2 3 4 Whats LIRADS Which cases is LIRADS Applied and v CONTENTS: 1 2 3 4 What’s LIRADS? Which cases is LIRADS Applied and](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-2.jpg)
v CONTENTS: 1 2 3 4 What’s LIRADS? Which cases is LIRADS Applied and not applied for? LIRADS ’ diagnostic categories Treatment and Prognosis through LIRADS
![1 WHAT IS LIRADS Ø Liver Imaging Reporting and Data System A classification 1. WHAT IS LIRADS? Ø Liver Imaging Reporting and Data System – A classification](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-3.jpg)
1. WHAT IS LIRADS? Ø Liver Imaging Reporting and Data System – A classification system for imaging findings in liver lesions. – The LI-RADS score for a liver lesion is an indication of its relative risk for hepatocellular carcinoma (HCC). – Standardization also helps interpret therapeutic performance. – The scoring system also potentially helps nonhepatologists interpret the potential suspiciousness of liver lesions in their patients.
![2 APPLY Ø In patients at high risk for HCC namely those with 2. ✓ APPLY Ø In patients at high risk for HCC, namely those with:](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-4.jpg)
2. ✓ APPLY Ø In patients at high risk for HCC, namely those with: • Cirrhosis • Chronic hepatitis B viral infection • Current or prior HCC Ø For multiphase exams performed with: • CT or MRI with extracellular contrast agents (ECA) OR • MRI with hepatobiliary contrast agents (HBA) ✘ DO NOT APPLY Ø In patients: • Without the above risk factors • < 18 years old • With cirrhosis due to: 1. Congenital hepatic fibrosis 2. A vascular disorder Ø Do not assign LI-RADS categories for observations: • That are path-proven malignancies OR • That are path-proven benign lesions of non-hepatocellular origin such as hemangiomas
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-5.jpg)
![v LR1 100 BENIGN Ø Imaging features diagnostic of a benign entity ü Cyst v LR-1 (100% BENIGN): Ø Imaging features diagnostic of a benign entity ü Cyst](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-6.jpg)
v LR-1 (100% BENIGN): Ø Imaging features diagnostic of a benign entity ü Cyst ü Hemangioma ü Vascular anomaly ü Perfusion alteration ü Hypertrophic pseudomass ü Confluent hepatic fibrosis ü Focal scar Ø Definite disappearance at follow up without treatment is also indicative of LR-1
![v LR2 PROBABLY BENIGN Ø Similar to LR1 Ø A solid 20 mm nodule v LR-2 (PROBABLY BENIGN): Ø Similar to LR-1. Ø A solid <20 mm nodule,](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-7.jpg)
v LR-2 (PROBABLY BENIGN): Ø Similar to LR-1. Ø A solid <20 mm nodule, without malignant / HCC / LR-M imaging features. § § T 1 Hyperintense § NO: APHE, T 2 Hypointense Washout, Siderotic Capsule, Growth HBP Hyperintense
![v LR3 LR4 LR5 BASED ON FEATURES Arterial phase Hyperenhancement APHE No v LR-3 ; LR-4 ; LR-5: BASED ON FEATURES: Arterial phase Hyperenhancement (APHE) No](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-8.jpg)
v LR-3 ; LR-4 ; LR-5: BASED ON FEATURES: Arterial phase Hyperenhancement (APHE) No APHE Enhancing “Capsule” Nonrim APHE Nonperipheral “Washout” Threshold Growth Size increase of a mass by ≥ 50% in ≤ 6 months
![v LR3 LR4 LR5 v LR-3 ; LR-4 ; LR-5](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-9.jpg)
v LR-3 ; LR-4 ; LR-5
![v SPECIAL CATEGORIES LRNC LRNon Categorizable ØFor lesions in which the technical quality of v SPECIAL CATEGORIES: LR-NC (LR-Non Categorizable): ØFor lesions in which the technical quality of](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-10.jpg)
v SPECIAL CATEGORIES: LR-NC (LR-Non Categorizable): ØFor lesions in which the technical quality of the MRI does not allow evaluation of the major features.
![v SPECIAL CATEGORIES q LRM Ø For liver lesions that are probably or definitely v SPECIAL CATEGORIES: q LR-M: Ø For liver lesions that are probably or definitely](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-11.jpg)
v SPECIAL CATEGORIES: q LR-M: Ø For liver lesions that are probably or definitely malignant, but not an appearance compatible with HCC.
![v SPECIAL CATEGORIES q LRTIV Ø For unequivocal enhancing soft tissue invading the portal v SPECIAL CATEGORIES: q LR-TIV: Ø For unequivocal enhancing soft tissue invading the portal](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-12.jpg)
v SPECIAL CATEGORIES: q LR-TIV: Ø For unequivocal enhancing soft tissue invading the portal vein, regardless of whether an underlying parenchymal mass is visible. Ø This is important to report since it is a contraindication to liver transplantation. Ø Malignancies other than HCC can invade the portal venous system.
![CASES CASES](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-13.jpg)
CASES
![1 ST CASE A 65 y o female patient with a medical history 1 ST CASE: • A 65 y. o female patient, with a medical history](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-14.jpg)
1 ST CASE: • A 65 y. o female patient, with a medical history of Cirrhosis. • AFP: 1194, 8 ng/ml; L 3: 8, 7%; DCP: 5801 m. AU/m. L. • CT-Scan: a 50 mm lesion in the right hepatic lobe.
![PRECONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-15.jpg)
PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-16.jpg)
![2 ND CASE A 70 y o male patient with Chronic hepatitis B 2 ND CASE: • A 70 y. o male patient, with Chronic hepatitis B](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-17.jpg)
2 ND CASE: • A 70 y. o male patient, with Chronic hepatitis B virus infection. • AFP: 9, 6 ng/ml; L 3: 4, 5%; DCP: 24 m. AU/m. L. • T 2 WI: a 14 mm lesion in the right hepatic lobe
![PRECONTRAST VENOUS PHASE PRIMOVIST ARTERIAL PHASE Hepatobiliary PHASE PRE-CONTRAST VENOUS PHASE PRIMOVIST ARTERIAL PHASE Hepatobiliary PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-18.jpg)
PRE-CONTRAST VENOUS PHASE PRIMOVIST ARTERIAL PHASE Hepatobiliary PHASE
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-19.jpg)
![3 RD CASE A 69 y o male patient with Chronic hepatitis infection 3 RD CASE: • A 69 y. o male patient, with Chronic hepatitis infection.](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-20.jpg)
3 RD CASE: • A 69 y. o male patient, with Chronic hepatitis infection. • T 2 WI: a 44 x 33 mm lesion in the segment IV.
![PRECONTRAST PRIMOVIST VENOUS PHASE ARTERIAL PHASE Hepatobiliary PHASE PRE-CONTRAST PRIMOVIST VENOUS PHASE ARTERIAL PHASE Hepatobiliary PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-21.jpg)
PRE-CONTRAST PRIMOVIST VENOUS PHASE ARTERIAL PHASE Hepatobiliary PHASE
![](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-22.jpg)
![4 TH CASE A 56 y o female patient with a medical history 4 TH CASE: • A 56 y. o female patient, with a medical history](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-23.jpg)
4 TH CASE: • A 56 y. o female patient, with a medical history of Chronic hepatitis B virus infection. • T 2 WI: a 18 mm lesion in the right hepatic lobe.
![PRECONTRAST VENOUS PHASE GADOVIST ARTERIAL PHASE DELAYED PHASE PRE-CONTRAST VENOUS PHASE GADOVIST ARTERIAL PHASE DELAYED PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-24.jpg)
PRE-CONTRAST VENOUS PHASE GADOVIST ARTERIAL PHASE DELAYED PHASE
![v LR2 PROBABLY BENIGN Ø Similar to LR1 Ø A solid 20 mm nodule v LR-2 (PROBABLY BENIGN) Ø Similar to LR-1. Ø A solid <20 mm nodule,](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-25.jpg)
v LR-2 (PROBABLY BENIGN) Ø Similar to LR-1. Ø A solid <20 mm nodule, without malignant / HCC / LR-M imaging features. § § T 1 Hyperintense § NO: APHE, T 2 Hypointense Washout, Siderotic Capsule, Growth HBP Hyperintense
![5 TH CASE A 49 y o male patient with Chronic hepatitis infection 5 TH CASE: • A 49 y. o male patient, with Chronic hepatitis infection](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-26.jpg)
5 TH CASE: • A 49 y. o male patient, with Chronic hepatitis infection • CT-Scan: a 37 mm lesion in the right hepatic lobe.
![PRECONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-27.jpg)
PRE-CONTRAST VENOUS PHASE ARTERIAL PHASE DELAYED PHASE
![4 Treatment and Prognosis LR 1 Continued routine surveillance LR 2 Continued routine surveillance 4. Treatment and Prognosis LR 1 Continued routine surveillance LR 2 Continued routine surveillance,](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-28.jpg)
4. Treatment and Prognosis LR 1 Continued routine surveillance LR 2 Continued routine surveillance, consider repeat diagnostic imaging in 6 months or less LR 3 Repeat or alternative diagnostic imaging in 3 -6 months LR 4 Multidisciplinary team discussion for tailored workup, may include biopsy LR 5 Diagnosis confirmed - plan treatment LR-NC Repeat or alternative diagnostic imaging in three months or less
![References Ø https radiopaedia orgarticleslirads langus Ø https www acr orgClinical ResourcesReportingandDataSystemsLIRADSCTMRILIRADSv 2018 References: Ø https: //radiopaedia. org/articles/li-rads? lang=us Ø https: //www. acr. org/Clinical. Resources/Reporting-and-Data-Systems/LIRADS/CT-MRI-LI-RADS-v 2018](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-29.jpg)
References: Ø https: //radiopaedia. org/articles/li-rads? lang=us Ø https: //www. acr. org/Clinical. Resources/Reporting-and-Data-Systems/LIRADS/CT-MRI-LI-RADS-v 2018
![THANKS FOR LISTENING THANKS FOR LISTENING!](https://slidetodoc.com/presentation_image/1352e8a76342f0d5efa453266844d5c2/image-30.jpg)
THANKS FOR LISTENING!
Dr nguyn
Tho nguyn
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