# CEUS LI-RADS — Contrast-enhanced ultrasound LI-RADS

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

**Situação:** vigente · **Órgão:** Fígado · **Órgão emissor:** American College of Radiology · **Versão:** v2017 · **Ano:** 2017

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: US
- Fonte primária: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 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. | 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. | 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. | 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. | 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. | 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. | 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). | PMC7000618 LR-TIV section ('enhancing tissue within a vein... early arrival time favors tumor in vein'). | ✓ |

### Citações por categoria
- **LR-1**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC7000618 (Terzi et al., 'CEUS LI-RADS: a pictorial review', Insights Imaging 2019), category and management sections for LR-1.
- **LR-2**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC7000618 category and management sections for LR-2.
- **LR-3**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC7000618 category and management sections for LR-3.
- **LR-4**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · 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**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC7000618 category and management sections for LR-5; pooled performance from PMC9929373 (Jiang et al., Quant Imaging Med Surg 2023) Results/Abstract.
- **LR-M**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC7000618 category and management sections for LR-M; corroborated by PMC9929373 Introduction (LR-M = probable malignancy but not HCC-specific).
- **LR-TIV**: Lyshchik A, Kono Y, Dietrich CF, et al.. CEUS LI-RADS: contrast-enhanced ultrasound Liver Imaging Reporting and Data System (2017) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC7000618 LR-TIV section ('enhancing tissue within a vein... early arrival time favors tumor in vein').

## Referências cruzadas
- _fronteira compartilhada_ → [LI-RADS — Liver Imaging Reporting and Data System, CT/MRI v2018](https://radcommons.laudos.ai/systems/li-rads-ct-mri-2018.md) — CEUS LI-RADS applies the LI-RADS framework to contrast-enhanced ultrasound.


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