# LI-RADS TR — LI-RADS Treatment Response

> Assesses response of treated HCC observations after locoregional therapy.

**Situação:** vigente · **Órgão:** Fígado · **Órgão emissor:** American College of Radiology · **Versão:** v2018 · **Ano:** 2018

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT, MRI
- Fonte primária: Kielar A, Fowler KJ, Lewis S, et al.. LI-RADS Treatment Response algorithm (CT/MRI) (2018) — 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 |
| --- | --- | --- | --- | --- | --- | --- |
| Nonviable | LR-TR Nonviable | Treated observation showing no perceived intralesional enhancement, or showing only expected post-treatment enhancement patterns (e.g., a thin uniform peripheral rim of enhancement) for the type of locoregional therapy used and the time elapsed since treatment. This category indicates no imaging evidence of gross (macroscopic) tumor viability, though it does not exclude microscopic tumor on histology. | Per the AASLD/LI-RADS consensus management suggestions cited in the source, a nonviable treated observation is managed with continued routine imaging surveillance; no measurement of viable tumor is reported. | Reflects low perceived probability of macroscopic tumor viability/recurrence. | PMC6920285 (Kierans/Chernyak et al., Insights Imaging 2019, LR-TR pictorial review) 'LR-TR response categories - LR-TR Nonviable'; cross-checked PMC5771991 (Abdom Radiol 2017) 'LI-RADS treatment response algorithm' | ✓ |
| Equivocal | LR-TR Equivocal | Treated observation with enhancement that cannot be confidently categorized as either viable or nonviable because of overlapping post-treatment enhancement features, in the absence of technical or patient-related limitations (i.e., the study is adequate but findings are indeterminate). | Source notes that for an equivocal response the decision to re-treat is weighed against short-interval follow-up imaging, typically after multidisciplinary discussion; if unsure between categories the algorithm directs choosing Equivocal. The viable-tumor size is still reported. | Intermediate / uncertain probability of residual or recurrent viable tumor. | PMC6920285 'LR-TR response categories - LR-TR Equivocal' and 'Pitfalls' / tie-breaking text; PMC5771991 'LI-RADS treatment response algorithm' | ✓ |
| Viable | LR-TR Viable | Treated observation with nodular, mass-like, or thick irregular tissue showing arterial-phase hyperenhancement (APHE), 'washout' appearance, or enhancement similar to the pre-treatment tumor. These features indicate macroscopic viable tumor with high certainty (applies to all locoregional therapies except radiation-based therapy, where intralesional enhancement and washout can persist for months before regressing). | Per the source, the largest single dimension of the enhancing (viable) tumor is measured and reported to guide re-treatment or alternative therapy; reporting the pre- and post-treatment category/size communicates magnitude of response and transplant/downstaging eligibility. | Reflects high perceived probability of residual/recurrent viable tumor. | PMC6920285 'LR-TR response categories - LR-TR Viable' and 'Management recommendations'; PMC5771991 'LI-RADS treatment response algorithm' | ✓ |
| Nonevaluable | LR-TR Nonevaluable | Treated observation in which treatment response cannot be assessed because of image degradation or omission — e.g., inadequate or absent multiphase post-contrast imaging, motion or other technical artifact, or missing pre-treatment comparison. The study quality, not the lesion biology, precludes assigning a viability category. | Per the source algorithm, a nonevaluable observation should be re-imaged after the technical limitation is corrected (repeat or optimized contrast-enhanced CT/MRI) so that a definitive LR-TR category can be assigned; no viable-tumor measurement is reported until evaluable. | No viability probability can be assigned — the category conveys uncertainty due to inadequate technique rather than a level of tumor-viability risk. | PMC6920285 (Kierans/Chernyak et al., Insights Imaging 2019) 'LR-TR response categories - LR-TR Nonevaluable' (treatment response cannot be evaluated due to image degradation/omission); corroborated by PMC5771991 (Mendiratta-Lala et al., Abdom Radiol 2017) 'LI-RADS treatment response algorithm'. | ✓ |

### Citações por categoria
- **Nonviable**: Kielar A, Fowler KJ, Lewis S, et al.. LI-RADS Treatment Response algorithm (CT/MRI) (2018) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC6920285 (Kierans/Chernyak et al., Insights Imaging 2019, LR-TR pictorial review) 'LR-TR response categories - LR-TR Nonviable'; cross-checked PMC5771991 (Abdom Radiol 2017) 'LI-RADS treatment response algorithm'
- **Equivocal**: Kielar A, Fowler KJ, Lewis S, et al.. LI-RADS Treatment Response algorithm (CT/MRI) (2018) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC6920285 'LR-TR response categories - LR-TR Equivocal' and 'Pitfalls' / tie-breaking text; PMC5771991 'LI-RADS treatment response algorithm'
- **Viable**: Kielar A, Fowler KJ, Lewis S, et al.. LI-RADS Treatment Response algorithm (CT/MRI) (2018) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC6920285 'LR-TR response categories - LR-TR Viable' and 'Management recommendations'; PMC5771991 'LI-RADS treatment response algorithm'
- **Nonevaluable**: Kielar A, Fowler KJ, Lewis S, et al.. LI-RADS Treatment Response algorithm (CT/MRI) (2018) — https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS · PMC6920285 (Kierans/Chernyak et al., Insights Imaging 2019) 'LR-TR response categories - LR-TR Nonevaluable' (treatment response cannot be evaluated due to image degradation/omission); corroborated by PMC5771991 (Mendiratta-Lala et al., Abdom Radiol 2017) 'LI-RADS treatment response algorithm'.

## Referências cruzadas
- _caracteriza_ → [LI-RADS — Liver Imaging Reporting and Data System, CT/MRI v2018](https://radcommons.laudos.ai/systems/li-rads-ct-mri-2018.md) — LI-RADS TR assesses treated observations categorized by diagnostic LI-RADS.


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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