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ECR 2018 / C-2952
Diagnosing Hepatocellular Carcinoma: A case-based guide to the practical application of Li-RADS 2017 in CT and MRI.
Congress: ECR 2018
Poster No.: C-2952
Type: Educational Exhibit
Keywords: Neoplasia, Multidisciplinary cancer care, Imaging sequences, MR, CT, Oncology, Liver, Abdomen
Authors: J. Bell, C. R. Smith, C. G. D. Clarke, R. Albazaz, A. Guthrie, E. Tjio, J. Wyatt, M. Sheridan; Leeds/UK



 Case  LI-RADS  Notes
Case 1 - Fig. 4 LR-4 The lesion has inherent high T1 signal making the multiphase CT invaluable to assess for arterial phase enhancement.

Case 2 - Fig. 5

N/A While the imaging features are of an LR-4 lesion the patient has Budd-Chiari and therefore LI-RADS should not be used.
Case 3 - Fig. 6 LR-2/3 initially then LR-3 On the first study the diagnostic table would assign LR-3 however the concentration of the hepatobiliary contrast agent would allow adjustment to LR-2. Subsequently the nodule became smaller however it no longer concentrates the hepatobiliary contrast agent, contradicting ancillary features mean no adjustment can be made.
Case 4 - Fig. 7 LR-TIV The associated infiltrative lesion is LR-5 and is contiguous with the portal vein thrombus, therefore this should be reported as "Definitely due to HCC".
Case 5 - Fig. 8 LR-1 Appearances are typical of a haemangioma and no further investigation is required.
Case 6 - Fig. 9 LR-5us initially then LR-5 At the initial MRI the lesion falls in the LR4/5 box of Fig. 3 As the lesion is visible on ultrasound and washes out this makes use of the LR-5us categorisation.
Case 7 - Fig. 10 LR-4 The lesion measures less than 2cm and is hypovascular. Ancillary features of non-enhancing capsule and hepatobiliary hypo-intensity upgrade this from LR3 to LR4.
Case 8 - Fig. 11 LR-5 Histology demonstrated a moderately differentiated hepatocellular carcinoma
with both trabecular and pseudoglandular patterns.
Case 9 - Fig. 12 LR-4 As the lesion is not hypervascular LR-4 is the maximum. Explant histology showed HCC.
Case 10 - Fig. 13 LR-4  
Case 11 -  Fig. 14 LR-5 This demonstrates all three major features of HCC.
Case 12 -  Fig. 15 LR-5  
Case 13 -  Fig. 16 LR-4  
Case 14 -  Fig. 17 LR-M The lesion demonstrates rim enhancement and there are no specific features of HCC so the lesion should be characterised as LR-M. Biopsy of the lesion demonstrated an atypical HCC with cholangio differentiation and the patient proceeded to transplant.
Case 15 -   Fig. 18 LR-M The lesion shows rim enhancement and there is a concentric pattern of diffusion restriction. Biopsy confirmed a cholangiocarcinoma.
Case 16 - Fig. 19 LR-2 LR-3 lesion with ancillary features of benignity (intralesional iron content). Explant pathology demonstrated some cell atypia but no HCC.
Case 17 - Fig. 20 LR-1  
Case 18 -  Fig. 21  LR-2 The lesion is not hypervascular as there is no change between the T1 pre and post contrast sequences. This would make the lesion LR-3. The hepatobiliary phase isointensity is an ancillary feature in favour of benignity.  Explant pathology showed a macroregenerative nodule.
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