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CEUS LI-RADS · Fígado
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CEUS LI-RADS Contrast-enhanced ultrasound LI-RADS

vigente

Categorization of liver observations on contrast-enhanced ultrasound in patients at risk for HCC.

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Escala de categorias
LR-1LR-2LR-3LR-4LR-5LR-MLR-TIV

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Procedência e vigência

Órgão emissor
American College of Radiology
Versão
v2017
Ano
2017
Família
léxico
Tipo de lógica
flat
Modalidade
US
Fonte primária
CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System
Última verificação
2026-06-26
Última checagem
2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)
{
  "categories": [
    "LR-1",
    "LR-2",
    "LR-3",
    "LR-4",
    "LR-5",
    "LR-M",
    "LR-TIV"
  ]
}

Categorias num relance

Cat.SignificadoCondutaRiscoFonte
LR-1
Definitely benign
Definitely benign at CEUS. Typical entities: simple cyst (no enhancement in any vascular phase), hemangioma (peripheral nodular/globular arterial enhancement with progressive centripetal fill-in), and focal fat deposition or sparing (isoenhancing to liver in all phases). No diagnostic uncertainty.		Return to routine surveillance, typically CEUS or other surveillance imaging in about 6 months.Definitely benign; effectively 0% probability of malignancy.
okfonte
PMC7000618 (Terzi et al., 'CEUS LI-RADS: a pictorial review', Insights Imaging 2019), category and management sections for LR-1.
LR-2
Probably benign
Probably benign at CEUS. Examples: solid nodule under 10 mm that is isoenhancing to liver in all phases; non-mass-like isoenhancing observation 10 mm or larger; atypically located focal fat deposition or sparing. Causes essentially no diagnostic concern.		Return to routine surveillance, typically repeat surveillance imaging in about 6 months.Probably benign; very low probability of malignancy.
okfonte
PMC7000618 category and management sections for LR-2.
LR-3
Intermediate probability
Intermediate probability of malignancy (similar chance of being benign vs HCC). Includes any nodule lacking both APHE and washout regardless of size; a nodule under 2 cm without APHE that shows late (>=60 s) and mild washout; or APHE without washout when the nodule is under 10 mm.		Repeat CEUS or alternative contrast imaging (CT or MRI) within about 6 months for re-evaluation.Intermediate probability of malignancy.
okfonte
PMC7000618 category and management sections for LR-3.
LR-4
Probably HCC
Probably HCC. Per CEUS LI-RADS v2017: nodule 2 cm or larger without APHE but with late (>=60 s) and mild washout; APHE without washout when the nodule is 10 mm or larger; or APHE with late and mild washout when the nodule is under 10 mm. Distinguished from LR-5 chiefly by size/washout combination (no washout, or sub-10 mm).		Multidisciplinary discussion for consensus management; if neither biopsy nor treatment is planned, repeat or alternative diagnostic imaging in about 3 months.High but not definitive probability of HCC.
okfonte
PMC7000618 category and management sections for LR-4; corroborated by PMC9929373 (Jiang et al. 2023) Discussion (LR-4 = same conditions as LR-5 but without washout).
LR-5
Definitely HCC
Definitely HCC. Nodule 10 mm or larger showing non-rim, non-peripheral-globular arterial-phase hyperenhancement (APHE) combined with LATE (onset >=60 s) and MILD washout. Late/mild washout is the key discriminator from LR-M (which shows early or marked washout).		Treat as HCC; multidisciplinary discussion for consensus management. May justify treatment without biopsy in a suitable lesion.Definitely HCC. In a CEUS LR-5 meta-analysis, pooled specificity was about 0.93 and sensitivity about 0.71 for HCC.
okfonte
PMC7000618 category and management sections for LR-5; pooled performance from PMC9929373 (Jiang et al., Quant Imaging Med Surg 2023) Results/Abstract.
LR-M
Probably or definitely malignant, not HCC specific
Probably or definitely malignant but not specific for HCC (e.g. intrahepatic cholangiocarcinoma, metastasis). Defined by any of: rim (ring-like) APHE; EARLY washout (onset <60 s); or MARKED washout (near-complete loss of enhancement within ~2 min). Early and/or marked washout separates LR-M from LR-5.		Multidisciplinary discussion for consensus management; may include alternative or repeat imaging, biopsy, or treatment.Probable or definite malignancy that is not HCC-specific.
okfonte
PMC7000618 category and management sections for LR-M; corroborated by PMC9929373 Introduction (LR-M = probable malignancy but not HCC-specific).
LR-TIV
Tumor in vein
Definite tumor in vein: unequivocal enhancing soft tissue within the lumen of a portal and/or hepatic vein, identified independently of any coexisting parenchymal mass. Early arterial arrival of enhancement (about the same time as the hepatic artery) favors tumor over bland thrombus.		Multidisciplinary discussion for consensus management; biopsy or biomarker correlation may be used to establish etiology.Indicates malignant vascular invasion; most are HCC, some intrahepatic cholangiocarcinoma or combined HCC-CCA. Etiology and prognosis track the associated parenchymal lesion (LR-4/5 vs LR-M).
okfonte
PMC7000618 LR-TIV section ('enhancing tissue within a vein... early arrival time favors tumor in vein').

Referências cruzadas

fronteira compartilhadaLI-RADS. Liver Imaging Reporting and Data System, CT/MRI v2018CEUS LI-RADS applies the LI-RADS framework to contrast-enhanced ultrasound.

Histórico de versões

Nenhum evento de versão registrado.

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