ACR CEUS LI-RADS 2016

ACR CEUS LI-RADS 2016

Liver Imaging Reporting and Data System

ACR CEUS LI-RADS, or CEUS LI-RADS for short, is a standardized system for technique, interpretation, reporting, and data collection for contrast-enhanced ultrasound (CEUS) exams in patients at risk for developing HCC. The system currently includes a lexicon of controlled terminology, schematic illustrations, and a categorization algorithm. A complete illustrative atlas, reporting guidelines, and educational material are in development. CEUS LI-RADS will be updated as experience accrues, as knowledge add technology advance, and in response to user feedback.

ACR CEUS LI-RADS was developed by a working group of national and international experts. The group is Chaired by Dr. Yuko Kono, MD, of the University of California, San Diego. Members include radiologists and hepatologists from the United States, Canada, Europe, and Asia. The group was convened in April 2014. Beta versions of the CEUS LI-RADS algorithm were presented at national and international conferences in 2015 and 2016. Feedback was solicited. Based on the feedback and iterative consensus, the working group refined and in 5-21-16 finalized the CEUS LI-RADS algorithm. The algorithm was officially approved by the ACR LI-RADS Steering Committee on 6-24-16 and submitted to the ACR for public release on 6-24-16.

LI-RADS-CEUS - Proposal for a Contrast-Enhanced Ultrasound Algorithm for the Diagnosis of Hepatocellular Carcinoma in High-Risk Populations.

Schellhaas B1, Wildner D1, Pfeifer L1, Goertz RS1, Hagel A1, Neurath MF1, Strobel D1.

Author information

Abstract

Purpose: To develop a contrast-enhanced ultrasound algorithm (LI-RADS-CEUS = liver imaging reporting and data system with contrast-enhanced ultrasound) for the diagnosis of hepatocellular carcinoma (HCC) in patients at risk. 

Materials and Methods: A CEUS algorithm (LI-RADS-CEUS) was designed analogously to CT- and MRI-based LI-RADS. LI-RADS-CEUS was evaluated retrospectively in 50 patients at risk with confirmed HCC or non-HCC lesions (test group) with subsequent validation in a prospective cohort of 50 patients (validation group). Results were compared to histology, CE-CT and CE-MRI as reference standards. 

Results: Tumor diagnosis in the test group/validation group (n = 50/50) were 46/41 HCCs, 3/3 intrahepatic cholangiocellular carcinomas (ICCs) and 1/6 benign lesions. The diagnostic accuracy of LI-RADS-CEUS for HCC, ICC and non-HCC-non-ICC-lesions was 89 %. For the diagnosis of HCC, the diagnostic accuracy was 93.5 % (43/46 cases) in the test group and 95.1 % (39/41 cases) in the validation group. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 %, 66.6 %, 94.3 % and 66.6 %, respectively (mean values from both cohorts). Histological findings of HCC were available in 40 versus 23 cases (in total: G1 / G2/G3: 15/35/13). Arterial hyperenhancement was seen in 68/87 (78.2 %) of HCCs. Arterial hyperenhancement with subsequent portal venous or late phase hypoenhancement was seen in 66 % of HCCs. 

Conclusion: LI-RADS-CEUS offers a CEUS algorithm for standardized assessment and reporting of focal liver lesions in patients at risk for HCC. Arterial hyperenhancement in CEUS is the key feature for the diagnosis of HCC in patients at risk, whereas washout is not a necessary prerequisite.

© Georg Thieme Verlag KG Stuttgart · New York.

ULTRASOUND at a DISTANCE: Tele-Mentored US Supported Medical Interactions Project

“We were MacGyvering off-the-shelf technology, cobbling this idea together on evenings and weekends, working around our schedules as clinicians,” says trauma surgeon Andrew Kirkpatrick, principal investigator on the Tele-Mentored Ultrasound Supported Medical Interactions (TMUSMI) project and Cumming School of Medicine professor. “This NEST funding is so exciting because it allows us to formalize our work and will accelerate our program a thousand-fold.”

The goal of Kirkpatrick’s group, which is co-led by former NASA flight surgeon Douglas Hamilton, is to develop protocols allowing an inexperienced clinician to be mentored at a distance through any unfamiliar medical assessment including, if necessary, ultrasound imaging.

The premise is that ultrasound technology is extremely useful, it’s getting cheaper and more available. But it requires experience to use, especially to avoid misinterpretation. And while available communications, like Skype, can work to facilitate distance diagnoses and assessments, the issue remains that — in trauma care particularly — time is critical. A delay of even five seconds is too much. So the challenge is to create smart, simplified ultrasound that provides instantaneous two-way communication.

“We picture ultrasound being as available one day as the defibrillators at the rink or the mall,” Kirkpatrick says. The team began this work 15 years ago; they are the most published people in the world in the field with a combined 50 years of experience designing and studying tele-medical instrumentation.

Their goals are likewise lofty: “We want to deliver rural, remote medical communities — and even space expeditions — with the speed, accuracy and convenience of urban-based point-of-care ultrasound and other lifesaving medical procedures.”

New Earth-space technologies are capturing, analyzing and visualizing our Earth-space environment through unprecedented advances in sensors, platforms and systems. We are on the cusp of a technological revolution in our ability to sense and monitor our natural environment and built world — with widespread applications for humanity. From the oldest science (astronomy) to the latest evolution of geomatics, University of Calgary researchers on the New Earth-Space Technologies Research Strategy team are providing information that is constantly changing how we make decisions about our world.