Objectives

- to present the CEUS LIRADS system

- to illustrate each stage of CEUS LIRADS reasoning with CEUS imaging cases

- to illustrate with clinical cases situations in which CEUS is usefull beside MRI

- to present possible limitation of CEUS LIRADS encountered in our experience.

Background

CEUS-LIRADS assigns categories for observations in cirrhotic or chronic hepatitis B livers in adults >18y. Categories are: CEUS-LR1 and 2: Definitely and probably benign; CEUS-LR3: intermediate probability of malignancy; CEUS-LR 4 and 5: probably and definitely HCC and CEUS LR-M: Probably or definitely malignant, not necessarily HCC.

Imaging findings OR Procedure findings

We will be using case material from several hundred CEUS examinations performed during the 15 past years in our institution. CEUS-LR-M is characterized only by a washout early (<60s) and/or marked. Observations can be intra hepatic cholangiocarcinomas, metastases, and HCC. In this case more often a poorly differentiated HCC. Assignment into CEUS-LR 3-5 is based on the size of the observation, the presence or not of an APHE, of washout (late (≥60s) and mild. CEUS eliminates possibility of arterial phase mistiming, thus allows detesection of APHE missed on MRI. Microbubbles are safe. However CEUS permits characterization of a limited number of observations and is not suitable for staging.

Conclusion

by introducing standardization in the reporting of observation in cirrhotic liver with CEUS, CEUS-LIRADS is at the origin of a significant improvement of the use of CEUS in cirrhotic liver as well as a clarification of its role which is now reintroduced in the last release of EASL guidelines