Letter to the Editor
Contrast Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System
(LI-RADS®): the official version by the American College of Radiology (ACR)
To the Editor: Schellhaas and her colleagues were in- feature (subtotal infiltration), and lacks an
We read with interest the article by spired by LI-RADS ® to propose a prelim- algorithmic display and cannot thus be
Schellhaas et al (B. Schellhaas et al. Ultra- inary CEUS system for liver nodule cate- considered consistent with the overall
schall in Med 2016; 37: 627–634). While gorization in at-risk patients. Their system ACR LI-RADS ® system. The official ACR
their study may contribute to the ongoing is similar to but not identical to the official algorithmic display for CEUS LI-RADS® is
validation of CEUS as a non-invasive meth- CEUS LI-RADS ® that was released in shown in ▶ Fig. 1.
od for HCC diagnosis in at-risk patients, we August 2016. Some differences between Having two different systems with
take exception to their inappropriate and their system and CEUS LI-RADS ® are the same name will have negative conse-
misleading adoption of the term “CEUS – shown in bold font in ▶ Table 1. quences, as it is likely to cause misunder-
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
LI-RADS”. As shown in the Table, their system standing and misapplication of the sys-
Based on good evidence (A. Sangiovan- omits one LI-RADS ® category (LR-3), tems. Potential users should be aware
ni et al. Gut 2010; 59: 638 – 644, S Leoni changes the name of one category that the system proposed by Schellhaas
et al. Ultraschall in Med 2013; 34: 280 – (LR-M), uses a different diameter thresh- et al. differs from the official ACR CEUS
287, MA Manini et al. J Hepatol 2014; 60: old for LR-5, modifies the terminology LI-RADS®.
995 – 1001), the American College of for APHE and washout, adds a new major
Radiology (ACR) convened a working
group of international experts to develop
ACR CEUS Liver Imaging Reporting And ▶ Table 1 Key Differences between ACR CEUS LI-RADS® and System Proposed by Schellhaas.
Data System (CEUS LI-RADS ® ) in 2014.
Beta versions of CEUS LI-RADS® algorithm ACR CEUS LI-RADS® Schellhaas system
were presented at numerous national and
international conferences in 2015 and population ▪ cirrhosis of any cause ▪ cirrhosis of any cause
2016 (e. g. D. Cosgrove. September 2015 ▪ chronic hepatitis B ▪ chronic hepatitis B
Bubble Conference in Chicago). Based on ▪ current or prior HCC ▪ treated HCC
feedback received after those presenta- ▪ chronic hepatitis C with
advanced fibrosis
tions and through iterative refinement
▪ NASH
and consensus, the working group com-
categories LR-1 (cyst, classic hemangioma, LR-1 (cyst)
pleted CEUS LI-RADS ® version 2016 in
definite focal fat deposition or
May 2016. The algorithm was officially ap- sparing)
proved by the ACR LI-RADS ® Steering
LR-2 LR-2
Committee in June 2016 and was pub-
lished online in August 2016 ([Link] LR-3 —
[Link]/quality-safety/resources/LIRADS). LR-4 LR-4
CEUS LI-RADS ® standardizes CEUS LR-5 LR-5
technique, interpretation, reporting, and LR-M LR-C
data collection for patients at risk for de-
LR-5V LR-V
veloping HCC. The system currently in-
diameter ≥ 10 mm ≥ 20 mm
cludes a lexicon of controlled terminology,
threshold
schematic illustrations, and a categoriza- for LR-5
tion algorithm. The ACR CEUS LI-RADS
other major APHE, not rim or peripheral APHE, not rim-like
classification was specifically designed to features for discontinuous
reflect scientific knowledge in CEUS, but LR-5
late (≥ 60 s) and mild washout washout in portal venous or late
also to remain consistent with the ACR phase, not < 60 s
CT/MRI LI-RADS ® classification. A com-
— subtotal infiltration of right/left
plete illustrative atlas, reporting guide- lobe
lines, and educational material are in
ancillary ▪ positive: diameter increase, —
development. CEUS LI-RADS ® will be
features nodule-in-nodule
updated as experience accrues, as knowl- ▪ negative: diameter reduction,
edge add technology advance, and in re- diameter stability ≥ 2y
sponse to user feedback. algorithmic yes no
As members of the CEUS LI-RADS ® display
Working Group, we are pleased that
Kono Y, Lyshchik A. Contrast Enhanced Ultrasound… Ultraschall in Med 2017; 38: 85–86 · DOI [Link] 85
Letter to the Editor
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
▶ Fig. 1 The official ACR algorithmic display for CEUS LI-RADS®.
2
Department of Radiology, Thomas Jefferson Correspondence
Respectfully and on behalf of the ACR University Hospitals, Philadelphia, United States
LI-RADS ® Steering Committee and ACR 3
Imperial and King’s Colleges, London, UK
Prof. Yuko Kono
CEUS LI-RADS® Working Group, 4
Innere Medizin 2, Caritas-Krankenhaus, Bad Department of Medicine and Radiology,
Mergentheim, Germany University of California
The Authors 5
Department of Medical Imaging, University of 200 W Arbor Dr
Toronto, Canada MC 8413
6 92103–8413 San Diego
Yuko Kono1, Andrej Lyshchik2, David Cosgrove3, Dept of Medical and Surgical Sciences, Div.
United States
Christoph F. Dietrich4, Hyun-Jung Jang5, Internal Medicine, Bologna, Italy
Tel.: ++ 1/6 19/5 43 20 61
Tae Kyoung Kim5, Fabio Piscaglia6, 7
Department of Radiology, Stanford University, ykono@[Link]
Juergen K. Willmann7, Stephanie R. Wilson8, Stanford, United States
Cynthia Santillan9, Avinash Kambadakone10, 8
Radiology and Medicine, Division of Bibliography
Donald Mitchell2, Alexander Vezeridis9,
Gastroenterology, University of Calgary, Canada DOI [Link]
Claude B. Sirlin9
9
Radiology, University of California, San Diego, Published online: 2017 | Ultraschall in Med 2017;
1 United States 38: 85–86
Department of Medicine, University of California,
10 © Georg Thieme Verlag KG Stuttgart · New York
San Diego, United States Radiology, Massachusetts General Hospital,
ISSN 0172-4614
Boston, United States
86 Kono Y, Lyshchik A. Contrast Enhanced Ultrasound… Ultraschall in Med 2017; 38: 85–86 · DOI [Link]
